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Gama G, Conceição Matias MD, de Luiz Vânia M, de Sales Regis T, Peregrino-Filho A, de Sales Tavares J, Amorim M, Melo A. Motor and cognitive response to intensive multidisciplinary therapy: the first reported case of congenital Zika virus syndrome. Physiother Theory Pract 2024; 40:1362-1371. [PMID: 36625893 DOI: 10.1080/09593985.2023.2165887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To provide a detailed description of the development of the first case of congenital Zika syndrome (CZS) to be reported in the literature worldwide. CASE DESCRIPTION This report describes the case of a child with CZS monitored from pregnancy until four years of age, with periodic evaluations of head circumference, weight, height, motor function according to the Gross Motor Function Measure (GMFM-88), and the occurrence of comorbidities. OUTCOMES The child's birth weight and length were normal (z-score = 1.1 and -1.95, respectively), while head circumference was below the expected value (z-score = -3.15). At 48 months, head circumference reached 43 cm (z-score = -4.48). During daily home physiotherapy sessions, the child achieved developmental milestones, standing unsupported at 17 months, with a GMFM-88x score of 137. With specialist therapy, the child walked independently at 36 months and a total GMFM-66 score of 214 was achieved by 42 months. In the four years of follow-up, the child was hospitalized four times for different reasons. No convulsive seizures occurred. CONCLUSIONS Despite severe neurological impairment, the child's weight and height are adequate for age, with motor and cognitive function improving over the first four years of life.
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Affiliation(s)
- Gabriela Gama
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil
- Campina Grande, UNIFACISA University Center, Paraíba, Brazil
| | | | - Mell de Luiz Vânia
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil
| | | | | | | | - Melania Amorim
- Instituto de Pesquisa Professor Jpaquim Amorim Neto and Instituto de Medicina Integral Professor Fernando Figueira
| | - Adriana Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil
- Campina Grande, UNIFACISA University Center, Paraíba, Brazil
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Gama GL, Ramos de Amorim MM, Alves da Silva Júnior R, Cristina de Sousa Santos A, Assunção PL, de Sales Tavares J, de Sales Regis T, de Sales Tavares J, Melo A. Effect of Intensive Physiotherapy Training for Children With Congenital Zika Syndrome: A Retrospective Cohort Study. Arch Phys Med Rehabil 2020; 102:413-422. [PMID: 33007306 DOI: 10.1016/j.apmr.2020.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the effect of intensive physiotherapy training on the motor function of children with congenital Zika syndrome (CZS). DESIGN A retrospective cohort study. SETTING A support center for children with microcephaly. PARTICIPANTS Children (N=7) aged 14 to 18 months old who were diagnosed with CZS and previously monitored more than 1 year. INTERVENTIONS A 2-stage protocol repeated uninterruptedly for 1 year. In the first stage, the children were submitted to 1 hour of conventional physiotherapy and 1 hour of suit therapy 5 times a week for 4 weeks. The second stage consisted of 1 hour of suit therapy 3 times a week for 2 weeks. MAIN OUTCOME MEASURES Gross motor function measure (GMFM) and body weight. RESULTS Six evaluations were conducted approximately 3 months apart. An increase in the overall GMFM score was observed between the first and second (P=.046), first and third (P=.018), first and fourth (P=.018), first and fifth (P=.043), and first and sixth evaluations (P=.018). Differences in the scores of the individual GMFM dimensions were found only for dimension A (lying and rolling) between the first and fourth evaluations (P=.027) and for dimension B (sitting) between the first and third (P=.018), first and fourth (P=.046), and first and sixth evaluations (P=.027). No difference was found in body weight between the first and sixth evaluations (P=.009). During follow-up, only 1 child required hospitalization, and another had increased irritability. CONCLUSIONS Children with CZS were able to perform 2 hours of motor physiotherapy daily with no serious complications, resulting in an increase or stabilization in GMFM scores.
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Affiliation(s)
- Gabriela Lopes Gama
- Professor Joaquim Amorim Neto Research Institute (IPESQ), Campina Grande, Paraíba, Brazil; UNIFACISA University Center, Campina Grande, Paraíba, Brazil
| | | | | | | | - Paula Lisiane Assunção
- Professor Joaquim Amorim Neto Research Institute (IPESQ), Campina Grande, Paraíba, Brazil
| | | | | | | | - Adriana Melo
- Professor Joaquim Amorim Neto Research Institute (IPESQ), Campina Grande, Paraíba, Brazil; UNIFACISA University Center, Campina Grande, Paraíba, Brazil.
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Mélo TR, Freitas J, Sabbag ADA, Chiarello CR, Neves EB, Israel VL. Intensive Neuromotor Therapy improves motor skills of children with Cornelia de Lange Syndrome: case report. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: The Cornelia de Lange Syndrome (CdLS) is a rare genetic syndrome. Children with CdLS usually require physical therapy, however the efficacy of physical therapy intervention in this population is lacking in the research literature. Objective: The aim of this study was to report the effect of Intensive Neuromotor Therapy (INMT) on gross motor function and participation of a child with CdLS using the International Classification of Functioning, Disabilities and Health (ICF) model. Method: A Brazilian child with CdLS was followed for over seven months while undergoing three modules of INMT. Results: The child demonstrated an evolution of gross motor function with gains of 11.28% in the first module, 9.22% in the second module, and 10.29% in the third module of INMT. Conclusion: INMT resulted in improvements in gross motor function and participation during daily activities in a child with CDLS. Further studies of larger cohorts are needed to investigate the efficacy of INMT in children with CdLS.
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Affiliation(s)
- Tainá Ribas Mélo
- Universidade Federal do Paraná, Brazil; Instituto Brasileiro de Terapias e Ensino, Brazil
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Martins E, Cordovil R, Oliveira R, Pinho J, Diniz A, Vaz JR. The Immediate Effects of a Dynamic Orthosis on Gait Patterns in Children With Unilateral Spastic Cerebral Palsy: A Kinematic Analysis. Front Pediatr 2019; 7:42. [PMID: 30847335 PMCID: PMC6393373 DOI: 10.3389/fped.2019.00042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/01/2019] [Indexed: 11/13/2022] Open
Abstract
This study analyzes the immediate effects of wearing a Therasuit on sagittal plane lower limb angular displacements during gait in children with unilateral spastic cerebral palsy (US-CP). Seven participants (median age = 7.00 years; ranging from 5.83 to 9.00 years) with US-CP, levels I and II of the Gross Motor Function Classification System, were assessed with kinematic gait analysis in three different conditions: (A) Baseline; (B) Therasuit without elastics and (C) Therasuit with elastics. Significant improvements were observed at the hip joint of both lower limbs during most of the gait cycle in participants wearing a Therasuit, including a decrease in the flexion pattern at the initial contact and swing phase in both lower limbs, and an increase in the extension pattern in the paretic lower limb during the stance phase. At the knee joint in the paretic lower limb, significant differences were found between the baseline and Therasuit with elastics conditions on the knee angle at initial contact, and between baseline and both Therasuit conditions on the flexion angle at swing phase. However, the inter-individual variability in kinematic patterns at the knee joint was high. At the ankle joint, decreased plantar flexion at initial contact and increased dorsiflexion during stance and swing phases were observed at the Therasuit with elastics condition, helping to correct the equinus-foot in the paretic lower limb during the whole gait cycle. The Z-values showed large effect sizes particularly for most of the angular hip variables in both lower limbs and for the angular ankle variables in the paretic lower limb. The Therasuit seems to have some positive immediate effects on gait kinematics in children with spastic unilateral cerebral palsy by providing a more functional and safer gait pattern. Future investigations with larger samples are recommended to further support these findings.
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Affiliation(s)
- Elisabete Martins
- Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal.,Escola Superior de Saúde do Alcoitão, Lisbon, Portugal
| | - Rita Cordovil
- Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal.,Faculdade de Motricidade Humana, CIPER, Universidade de Lisboa, Lisbon, Portugal
| | - Raul Oliveira
- Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Joana Pinho
- Escola Superior de Saúde do Alcoitão, Lisbon, Portugal
| | - Ana Diniz
- Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal.,Faculdade de Motricidade Humana, CIPER, Universidade de Lisboa, Lisbon, Portugal
| | - Joao R Vaz
- Universidade Europeia, Lisbon, Portugal.,Department of Biomechanics, University of Nebraska, Omaha, NE, United States
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Effects of Suit-Orthosis on Postural Adjustments During Seated Reaching Task in Children With Cerebral Palsy. Pediatr Phys Ther 2018; 30:231-237. [PMID: 29924076 DOI: 10.1097/pep.0000000000000519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM To investigate suit-orthosis effects on postural sway during anticipatory and compensatory postural adjustments (APA and CPA, respectively) in a seated reaching task performed by children with cerebral palsy (CP). METHODS Twenty-nine children were divided according to Manual Ability Classification System (MACS) I and II-III. Participants were instructed to reach forward toward an object both in a no-suit condition and in a suit-orthosis condition. RESULTS Using the suit-orthosis, children at MACS II-III decreased velocity of center-of-pressure (CoP) sway during APA, whereas children at MACS I increased the anterior-posterior CoP displacement during CPA. CONCLUSION Suit-orthosis improved postural stability in children at MACS II-III during APA. The suit may assist with arm function control during postural sway when preparing to reach for objects. CLINICAL IMPLICATIONS Suit-orthoses in therapy should be individually prescribed considering the intended activity and person's motor impairment.
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Almeida KM, Fonseca ST, Figueiredo PRP, Aquino AA, Mancini MC. Effects of interventions with therapeutic suits (clothing) on impairments and functional limitations of children with cerebral palsy: a systematic review. Braz J Phys Ther 2017; 21:307-320. [PMID: 28712784 PMCID: PMC5628369 DOI: 10.1016/j.bjpt.2017.06.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/25/2016] [Accepted: 09/26/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Therapeutic suits or clothing whether associated with intensive protocols or not, became popular in the rehabilitation of children with cerebral palsy. Studies have reported positive effects of these suits on children's posture, balance, motor function and gait. A summary of current literature may help guide therapeutic actions. OBJECTIVE To evaluate the available evidence on the effects of interventions based on the use of therapeutic suits in the treatment of impairments and functional limitations of children with cerebral palsy. METHOD Three independent reviewers searched for experimental studies on MEDLINE, SciELO, BIREME, LILACS, PEDro and CENTRAL databases, between October and December 2015 and updated in May 2016. The reviewers evaluated the methodological quality of selected studies using the Checklist for Measuring Quality. The Grading of Recommendations Assessment, Development and Evaluation was used to synthesize the quality of evidence and strength of recommendation. RESULTS From the 13 studies, two evaluated the Full Body Suit, two tested the Dynamic Elastomeric Fabric Orthose, three evaluated TheraTogs and six tested the TheraSuit/AdeliSuit protocols. The quality of evidence for the Full Body Suit, the Dynamic Elastomeric Fabric Orthose and the TheraSuit/AdeliSuit protocols was very low for body structure and function outcomes, while the evidence for TheraTogs was low quality. Regarding the activity outcomes, the Full Body Suit and TheraSuit showed very low quality evidence while the evidence for TheraSuit/AdeliSuit protocols were of low quality. CONCLUSION Enthusiasm with new therapeutic approaches that argue modifications in the neuromusculoskeletal impairments and functional limitations of children with cerebral palsy need to be guided by scientific evaluation. The low quality of evidence suggests caution in recommending the use of these therapeutic suits. New studies could change the findings of this review.
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Affiliation(s)
- Kênnea M Almeida
- Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Sérgio T Fonseca
- Programa de Pós-Graduação em Ciências da Reabilitação, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Amanda A Aquino
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Marisa C Mancini
- Programa de Pós-Graduação em Ciências da Reabilitação, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
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Martins E, Cordovil R, Oliveira R, Letras S, Lourenço S, Pereira I, Ferro A, Lopes I, Silva CR, Marques M. Efficacy of suit therapy on functioning in children and adolescents with cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol 2016; 58:348-60. [PMID: 26613800 DOI: 10.1111/dmcn.12988] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2015] [Indexed: 01/01/2023]
Abstract
AIM This systematic review and meta-analysis presents an overview of the efficacy of suit therapy on functioning in children and adolescents with cerebral palsy (CP). METHOD A systematic review with meta-analysis was conducted. A comprehensive search of peer-reviewed articles was performed on electronic databases, from their inception to May 2014. Studies included were rated for methodological quality using the Physiotherapy Evidence Database scale. Effects of suit therapy on functioning were assessed using meta-analytic techniques. RESULTS From the 46 identified studies, four met the inclusion criteria and were included in the meta-analysis. Small, pooled effect sizes were found for gross motor function at post-treatment (g=0.46, 95% confidence interval [CI] 0.10-0.82) and follow-up (g=0.47, 95% CI 0.03-0.90). INTERPRETATION The small number of studies, the variability between them, and the low sample sizes are limitations of this review. Findings suggest that to weigh and balance benefits against harms, clinicians, patients, and families need better evidence to examine and prove the effects of short intensive treatment such as suit therapy on gross motor function in children and adolescents with CP. Therefore, more research based on high-quality studies focusing on functioning in all dimensions of the International Classification of Functioning, Disability and Health perspective is necessary to clarify the impact of suit therapy.
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Affiliation(s)
- Elisabete Martins
- Laboratory of Motor Behavior, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Rita Cordovil
- Laboratory of Motor Behavior, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal.,CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Raul Oliveira
- Laboratory of Motor Behavior, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Sara Letras
- Escola Superior de Saúde do Alcoitão, Lisbon, Portugal
| | | | - Inês Pereira
- Escola Superior de Saúde do Alcoitão, Lisbon, Portugal
| | - Ana Ferro
- Escola Superior de Saúde do Alcoitão, Lisbon, Portugal
| | - Inês Lopes
- Escola Superior de Saúde do Alcoitão, Lisbon, Portugal
| | | | - Marta Marques
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
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