O uso da eletromiografia de superfície como medida de desfecho da fisioterapia em crianças com paralisia cerebral: uma revisão sistemática
DOI:
https://doi.org/10.7322/jhgd.v30.10368Palavras-chave:
Paralisia cerebral, Fisioterapia, EletromiografiaResumo
Introdução: A paralisia cerebral é a deficiência física mais comum na infância. A fisioterapia desempenha um papel central na gestão do tratamento das sequelas da PC. Contudo, é sempre um desafio conseguir quantificar os resultados obtidos nas intervenções fisioterapêuticas. Dessa forma, a eletromiografia de superfície vem sendo cada vez mais empregada por fisioterapeutas por ser um método quantitativo de avaliação e tratamento das disfunções do sistema neuromuscular.
Objetivo: Analisar o uso da eletromiografia de superfície como medida de desfecho da fisioterapia em crianças com paralisia cerebral.
Método: A partir da busca em duas importantes bases de dados, foram selecionados ensaios clínicos de intervenções fisioterapêuticas que utilizaram a eletromiografia de superfície como fator de desfecho da fisioterapia em crianças com paralisia cerebral, publicados em português, inglês, francês ou espanhol até agosto de 2019.
Resultados: Foram encontrados 166 artigos nas bases consultadas. Desses, somente 15 foram incluídos e classificados com qualidade metodológica boa pelo PEDro e por terem relação com a eletromiografia de superfície. Um fluxograma com padronização das ações foi construído levando em consideração os achados mais prevalentes nos estudos.
Conclusão: a eletromiografia de superfície vem sendo aplicada pelos fisioterapeutas para avaliar os efeitos da intervenção, mas precisa melhorar seu nível de evidência.
Referências
1. Englander ZA, Sun J, Case L, Mikati MA, Kurtzberg J, Songa AW. Brain structural connectivity increases concurrent with functional improvement: Evidence from diffusion tensor MRI in children with cerebral palsy during therapy. Neuroimage Clin. 2015;7:315-24. DOI: http://doi.org/10.1016/j.nicl.2015.01.002
2. Centers for Disease Control and Prevention (CDC). Data and Statistics for Cerebral Palsy. [internet] 2016 [cited 2020 May 12] Available from: https://www.cdc.gov/ncbddd/cp/data.html.
3. Surveillance of Cerebral Palsy in Europe (SCPE). Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol. 2000;42(12):816-24. DOI: http://doi.org/10.1017/s0012162200001511
4. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Diretrizes de atenção à pessoa com paralisia cerebral. Brasília: Ministério da Saúde, 2014.
5. Hegarty AK, Kurz MJ, Stuberg W, Silverman AK. Changes in Mobility and Muscle Function of Children with Cerebral Palsy after Gait Training: A Pilot Study. J Appl Biomech. 2016;32(5):469-86. DOI: http://doi.org/10.1123/jab.2015-0311
6. Anttila H, Autti-Rämö I, Suoranta J, Mäkelä M, Malmivaara A. Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review. BMC Pediatr. 2008;8:14. DOI: http://doi.org/10.1186/1471-2431-8-14
7. Brown GT, Burns SA. The efficacy of neurodevelopmental treatments in Paediatrics: a systematic review. Br J Occupational Therapy. 2001;64(5):235-44. DOI: https://doi.org/10.1177/030802260106400505
8. Dodd KJ, Taylor NF, Damiano DL. A systematic review of the effectiveness of strength training programs for people with cerebral palsy. Arch Phys Med Rehabil. 2002;83(8):1157-64. DOI: https://doi.org/10.1053/apmr.2002.34286
9. Moreau NG, Bodkin AW, Bjornson K, Hobbs A, Soileau M, Lahasky K. Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis. Phys Ther. 2016;96(12):1938-54. DOI: https://doi.org/10.2522/ptj.20150401
10. Park EJ, Baek SH, Park S. Systematic review of the effects of mirror therapy in children with cerebral palsy. J Phys Ther Sci. 2016;28(11):3227-31. DOI: https://doi.org/10.1589/jpts.28.3227
11. Saquetto M, Carvalho V, Silva C, Conceição C, Gomes-Neto M. The effects of whole body vibration on mobility and balance in children with cerebral palsy: a systematic review with meta-analysis. J Musculoskelet Neuronal Interact. 2015;15(2):137-44.
12. Whalen CN, Case-Smith J. Therapeutic Effects of Horseback Riding Therapy on Gross Motor Function in Children with Cerebral Palsy: A Systematic Review. Phys Occup Ther Pediatr. 2012;32(3):229-42. DOI: https://doi.org/10.3109/01942638.2011.619251
13. Carr JH, shepherd RB. The changing face of neurological rehabilitation. Rev Bras Fisioter. 2006;10(2):147-56. DOI: https://doi.org/10.1590/S1413-35552006000200003
14. Ocarino JM, Silva PLP, Vaz DV, Aquino CF, Brício RS, Fonseca ST. Eletromiografia: interpretação e aplicações nas ciências da reabilitação. Fisioter Bras. 2005;6(4):305-10.
15. Shiwa SR, Costa LOP, Moser ADL, Aguiar IC, Oliveira LVF. PEDro: a base de dados de evidências em fisioterapia. Fisioter Mov. 2011;24(3):523-33. DOI: https://doi.org/10.1590/S0103-51502011000300017
16. McGibbon NH, Benda W, Duncan BR, Silkwood-Sherer D. Immediate and long-term effects of hippotherapy on symmetry of adductor muscle activity and functional ability in children with spastic cerebral palsy. Arch Phys Med Rehabil. 2009;90(6):966-74. DOI: https://doi.org/10.1016/j.apmr.2009.01.011
17. Fowler EG, Ho TW, Nwigwe AI, Dorey FJ. The effect of quadriceps femoris muscle strengthening exercises on spasticity in children with cerebral palsy. Phys Ther. 2001;81(6):1215-23.
18. Benda W, McGibbon NH, Grant KL. Improvements in muscle symmetry in children with cerebral palsy after equine-assisted therapy (hippotherapy). J Altern Complement Med. 2003;9(6):817-25. DOI: https://doi.org/10.1089/107555303771952163
19. Hodapp M, Vry J, Mall V, Faist M. Changes in soleus H-reflex modulation after treadmill training in children with cerebral palsy. Changes in soleus H-reflex modulation after treadmill training in children with cerebral palsy. Brain. 2009;132(Pt 1):37-44. DOI: https://doi.org/10.1093/brain/awn287
20. Stearns GE, Burtner P, Keenan KM, Qualls C, Phillips J. Effects of constraint-induced movement therapy on hand skills and muscle recruitment of children with spastic hemiplegic cerebral palsy. NeuroRehabilitation. 2009;24(2):95-108. DOI: https://doi.org/10.3233/NRE-2009-0459
21. Reid S, Hamer P, Alderson J, Lloyd D. Neuromuscular adaptations to eccentric strength training in children and adolescents with cerebral palsy. Dev Med Child Neurol. 2010;52(4):358-63. DOI: https://doi.org/10.1111/j.1469-8749.2009.03409.x
22. Liao HF, Gan SM, Lin KH, Lin JJ. Effects of weight resistance on the temporal parameters and electromyography of sit-to-stand movements in children with and without cerebral palsy. Am J Phys Med Rehabil. 2010;89(2):99-106. DOI: https://doi.org/10.1097/PHM.0b013e3181c55874
23. Trócoli T, Oliveira L, Kanashiro M, Braga D, Cyrillo F. Electromyographic analysis of quadriceps muscle among children with cerebral palsy underwater and on dry ground. [internet] 2011 [cited 2020 May 12] Available from: http://fisioaquaticafuncional.com.br/resources/WPT2011_Poster.pdf
24. Bigongiari A, Souza FA, Franciulli PM, Neto Sel R, Araujo RC, Mochizuki L. Anticipatory and compensatory postural adjustments in sitting in children with cerebral palsy. Hum Mov Sci. 2011;30(3):648-57. DOI: https://doi.org/10.1016/j.humov.2010.11.006
25. Arya BK, Mohapatra J, Subramanya K, Prasad H, Kumar R, Mahadevappa M. Surface EMG analysis and changes in gait following electrical stimulation of quadriceps femoris and tibialis anterior in children with spastic cerebral palsy. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:5726-9. DOI: https://doi.org/10.1109/EMBC.2012.6347295
26. Santos CG, Pagnussat AS, Simon AS, Py R, Pinho AS, Wagner MB. Humeral external rotation handling by using the Bobath concept approach affects trunk extensor muscles electromyography in children with cerebral palsy. Res Dev Disabil. 2015;36C:134-41. DOI: https://doi.org/10.1016/j.ridd.2014.09.013
27. Simon AS, Pinho AS, Santos CG, Pagnussat AS. Facilitation handlings induce increase in electromyographic activity of muscles involved in head control of cerebral palsy children. Res Dev Disabil. 2014;35(10):2547-57. DOI: https://doi.org/10.1016/j.ridd.2014.06.018
28. Xu K, LuHe, Mai J, Yan X, Chen Y. Muscle Recruitment and Coordination following Constraint-Induced Movement Therapy with Electrical Stimulation on Children with Hemiplegic Cerebral Palsy: A Randomized Controlled Trial. PLoS One. 2015;10(10):e0138608. DOI: https://doi.org/10.1371/journal.pone.0138608
29. Mukhopadhyay R, Lenka PK, Biswas A, Mahadevappa M. Evaluation of Functional Mobility Outcomes Following Electrical Stimulation in Children with Spastic Cerebral Palsy. J Child Neurol. 2017;32(7):650-6. DOI: https://doi.org/10.1177/0883073817700604
30. Ribeiro MF, Espindula AP, Lage JB, Bevilacqua Júnior DE, Diniz LH, Mello EC, et al. Analysis of the electromiographic activity of lower limb and motor function in hippotherapy practitioners with cerebral palsy. J Bodyw Mov Ther. 2019; 23(1):39-47. DOI: https://doi.org/10.1016/j.jbmt.2017.12.007
31. Palisano R, Rosenbaum P,Walter S , Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-23. DOI: https://doi.org/10.1111/j.1469-8749.1997.tb07414.x
32. Eliasson AC, Krumlinde-Sundholm L, Rösblad B, Beckung E, Arner M, Ohrvall AM, et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol. 2006;48(7):549-54. DOI: https://doi.org/10.1017/S0012162206001162
33. Ferreira AS, Guimarães FS, Silva JG. Aspectos Metodológicos da Eletromiografia de Superfície: Considerações sobre os sinais e processamentos para estudo da função neuromuscular. Rev Bras Cienc Esporte. 2010;31(2):11-30.
34. Portney L, Roy SH. Eletromiografia e testes de velocidade de condução nervosa. Fisioterapia avaliação e tratamento. 4 ed. São Paulo: Manole, 2004; p. 213-56.
35. De Luca CJ. The Use of Surface Electromyography in Biomechanics. J Appl Biomech. 1997;13(2):135-63. DOI: https://doi.org/10.1123/jab.13.2.135
36. Damiano DL, Alter KE, Chambers H. New Clinical and Research Trends in Lower Extremity Management for Ambulatory Children with Cerebral Palsy. Phys Med Rehabil Clin N Am. 2009;20(3):469-91. DOI: https://doi.org/10.1016/j.pmr.2009.04.005
37. Tank FF, Silva GT, Oliveira CG, Garcia MAC. Influência da distância intereletrodos e da cadencia de movimento no domínio da frequência do sinal de EMG de superfície. Rev Bras Med Esporte. 2009;15(4):272-6. DOI: https://doi.org/10.1590/S1517-86922009000500008
38. Zhou J, Butler EE, Rose J. Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment. Front Hum Neurosci. 2017;11:103. DOI: https://doi.org/10.3389/fnhum.2017.00103
39. Labarre-Vila A. Assessment of muscle function in pathology with surface electrode EMG. Rev Neurol (Paris). 2006;162(4):459-65. DOI: https://doi.org/10.1016/s0035-3787(06)75037-8
40. Nielsen JLG, Holmgaard S, Jiang N, Englehart KB, Farina D, Parker PA. Simultaneous and proportional force estimation for multifunction myoelectric prostheses using mirrored bilateral training. IEEE Trans Biomed Eng. 2011;58(3):681-8. DOI: https://doi.org/10.1109/TBME.2010.2068298
41. Li H, Zhao G, Zhou Y, Chen X, Ji Z, Wang L. Relationship of EMG/SMG features and muscle strength level: an exploratory study on tibialis anterior muscles during plantar-flexion among hemiplegia patients. Biomed Eng Online. 2014;13:5. DOI: https://doi.org/10.1186/1475-925X-13-5
2. Centers for Disease Control and Prevention (CDC). Data and Statistics for Cerebral Palsy. [internet] 2016 [cited 2020 May 12] Available from: https://www.cdc.gov/ncbddd/cp/data.html.
3. Surveillance of Cerebral Palsy in Europe (SCPE). Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol. 2000;42(12):816-24. DOI: http://doi.org/10.1017/s0012162200001511
4. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Diretrizes de atenção à pessoa com paralisia cerebral. Brasília: Ministério da Saúde, 2014.
5. Hegarty AK, Kurz MJ, Stuberg W, Silverman AK. Changes in Mobility and Muscle Function of Children with Cerebral Palsy after Gait Training: A Pilot Study. J Appl Biomech. 2016;32(5):469-86. DOI: http://doi.org/10.1123/jab.2015-0311
6. Anttila H, Autti-Rämö I, Suoranta J, Mäkelä M, Malmivaara A. Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review. BMC Pediatr. 2008;8:14. DOI: http://doi.org/10.1186/1471-2431-8-14
7. Brown GT, Burns SA. The efficacy of neurodevelopmental treatments in Paediatrics: a systematic review. Br J Occupational Therapy. 2001;64(5):235-44. DOI: https://doi.org/10.1177/030802260106400505
8. Dodd KJ, Taylor NF, Damiano DL. A systematic review of the effectiveness of strength training programs for people with cerebral palsy. Arch Phys Med Rehabil. 2002;83(8):1157-64. DOI: https://doi.org/10.1053/apmr.2002.34286
9. Moreau NG, Bodkin AW, Bjornson K, Hobbs A, Soileau M, Lahasky K. Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis. Phys Ther. 2016;96(12):1938-54. DOI: https://doi.org/10.2522/ptj.20150401
10. Park EJ, Baek SH, Park S. Systematic review of the effects of mirror therapy in children with cerebral palsy. J Phys Ther Sci. 2016;28(11):3227-31. DOI: https://doi.org/10.1589/jpts.28.3227
11. Saquetto M, Carvalho V, Silva C, Conceição C, Gomes-Neto M. The effects of whole body vibration on mobility and balance in children with cerebral palsy: a systematic review with meta-analysis. J Musculoskelet Neuronal Interact. 2015;15(2):137-44.
12. Whalen CN, Case-Smith J. Therapeutic Effects of Horseback Riding Therapy on Gross Motor Function in Children with Cerebral Palsy: A Systematic Review. Phys Occup Ther Pediatr. 2012;32(3):229-42. DOI: https://doi.org/10.3109/01942638.2011.619251
13. Carr JH, shepherd RB. The changing face of neurological rehabilitation. Rev Bras Fisioter. 2006;10(2):147-56. DOI: https://doi.org/10.1590/S1413-35552006000200003
14. Ocarino JM, Silva PLP, Vaz DV, Aquino CF, Brício RS, Fonseca ST. Eletromiografia: interpretação e aplicações nas ciências da reabilitação. Fisioter Bras. 2005;6(4):305-10.
15. Shiwa SR, Costa LOP, Moser ADL, Aguiar IC, Oliveira LVF. PEDro: a base de dados de evidências em fisioterapia. Fisioter Mov. 2011;24(3):523-33. DOI: https://doi.org/10.1590/S0103-51502011000300017
16. McGibbon NH, Benda W, Duncan BR, Silkwood-Sherer D. Immediate and long-term effects of hippotherapy on symmetry of adductor muscle activity and functional ability in children with spastic cerebral palsy. Arch Phys Med Rehabil. 2009;90(6):966-74. DOI: https://doi.org/10.1016/j.apmr.2009.01.011
17. Fowler EG, Ho TW, Nwigwe AI, Dorey FJ. The effect of quadriceps femoris muscle strengthening exercises on spasticity in children with cerebral palsy. Phys Ther. 2001;81(6):1215-23.
18. Benda W, McGibbon NH, Grant KL. Improvements in muscle symmetry in children with cerebral palsy after equine-assisted therapy (hippotherapy). J Altern Complement Med. 2003;9(6):817-25. DOI: https://doi.org/10.1089/107555303771952163
19. Hodapp M, Vry J, Mall V, Faist M. Changes in soleus H-reflex modulation after treadmill training in children with cerebral palsy. Changes in soleus H-reflex modulation after treadmill training in children with cerebral palsy. Brain. 2009;132(Pt 1):37-44. DOI: https://doi.org/10.1093/brain/awn287
20. Stearns GE, Burtner P, Keenan KM, Qualls C, Phillips J. Effects of constraint-induced movement therapy on hand skills and muscle recruitment of children with spastic hemiplegic cerebral palsy. NeuroRehabilitation. 2009;24(2):95-108. DOI: https://doi.org/10.3233/NRE-2009-0459
21. Reid S, Hamer P, Alderson J, Lloyd D. Neuromuscular adaptations to eccentric strength training in children and adolescents with cerebral palsy. Dev Med Child Neurol. 2010;52(4):358-63. DOI: https://doi.org/10.1111/j.1469-8749.2009.03409.x
22. Liao HF, Gan SM, Lin KH, Lin JJ. Effects of weight resistance on the temporal parameters and electromyography of sit-to-stand movements in children with and without cerebral palsy. Am J Phys Med Rehabil. 2010;89(2):99-106. DOI: https://doi.org/10.1097/PHM.0b013e3181c55874
23. Trócoli T, Oliveira L, Kanashiro M, Braga D, Cyrillo F. Electromyographic analysis of quadriceps muscle among children with cerebral palsy underwater and on dry ground. [internet] 2011 [cited 2020 May 12] Available from: http://fisioaquaticafuncional.com.br/resources/WPT2011_Poster.pdf
24. Bigongiari A, Souza FA, Franciulli PM, Neto Sel R, Araujo RC, Mochizuki L. Anticipatory and compensatory postural adjustments in sitting in children with cerebral palsy. Hum Mov Sci. 2011;30(3):648-57. DOI: https://doi.org/10.1016/j.humov.2010.11.006
25. Arya BK, Mohapatra J, Subramanya K, Prasad H, Kumar R, Mahadevappa M. Surface EMG analysis and changes in gait following electrical stimulation of quadriceps femoris and tibialis anterior in children with spastic cerebral palsy. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:5726-9. DOI: https://doi.org/10.1109/EMBC.2012.6347295
26. Santos CG, Pagnussat AS, Simon AS, Py R, Pinho AS, Wagner MB. Humeral external rotation handling by using the Bobath concept approach affects trunk extensor muscles electromyography in children with cerebral palsy. Res Dev Disabil. 2015;36C:134-41. DOI: https://doi.org/10.1016/j.ridd.2014.09.013
27. Simon AS, Pinho AS, Santos CG, Pagnussat AS. Facilitation handlings induce increase in electromyographic activity of muscles involved in head control of cerebral palsy children. Res Dev Disabil. 2014;35(10):2547-57. DOI: https://doi.org/10.1016/j.ridd.2014.06.018
28. Xu K, LuHe, Mai J, Yan X, Chen Y. Muscle Recruitment and Coordination following Constraint-Induced Movement Therapy with Electrical Stimulation on Children with Hemiplegic Cerebral Palsy: A Randomized Controlled Trial. PLoS One. 2015;10(10):e0138608. DOI: https://doi.org/10.1371/journal.pone.0138608
29. Mukhopadhyay R, Lenka PK, Biswas A, Mahadevappa M. Evaluation of Functional Mobility Outcomes Following Electrical Stimulation in Children with Spastic Cerebral Palsy. J Child Neurol. 2017;32(7):650-6. DOI: https://doi.org/10.1177/0883073817700604
30. Ribeiro MF, Espindula AP, Lage JB, Bevilacqua Júnior DE, Diniz LH, Mello EC, et al. Analysis of the electromiographic activity of lower limb and motor function in hippotherapy practitioners with cerebral palsy. J Bodyw Mov Ther. 2019; 23(1):39-47. DOI: https://doi.org/10.1016/j.jbmt.2017.12.007
31. Palisano R, Rosenbaum P,Walter S , Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-23. DOI: https://doi.org/10.1111/j.1469-8749.1997.tb07414.x
32. Eliasson AC, Krumlinde-Sundholm L, Rösblad B, Beckung E, Arner M, Ohrvall AM, et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol. 2006;48(7):549-54. DOI: https://doi.org/10.1017/S0012162206001162
33. Ferreira AS, Guimarães FS, Silva JG. Aspectos Metodológicos da Eletromiografia de Superfície: Considerações sobre os sinais e processamentos para estudo da função neuromuscular. Rev Bras Cienc Esporte. 2010;31(2):11-30.
34. Portney L, Roy SH. Eletromiografia e testes de velocidade de condução nervosa. Fisioterapia avaliação e tratamento. 4 ed. São Paulo: Manole, 2004; p. 213-56.
35. De Luca CJ. The Use of Surface Electromyography in Biomechanics. J Appl Biomech. 1997;13(2):135-63. DOI: https://doi.org/10.1123/jab.13.2.135
36. Damiano DL, Alter KE, Chambers H. New Clinical and Research Trends in Lower Extremity Management for Ambulatory Children with Cerebral Palsy. Phys Med Rehabil Clin N Am. 2009;20(3):469-91. DOI: https://doi.org/10.1016/j.pmr.2009.04.005
37. Tank FF, Silva GT, Oliveira CG, Garcia MAC. Influência da distância intereletrodos e da cadencia de movimento no domínio da frequência do sinal de EMG de superfície. Rev Bras Med Esporte. 2009;15(4):272-6. DOI: https://doi.org/10.1590/S1517-86922009000500008
38. Zhou J, Butler EE, Rose J. Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment. Front Hum Neurosci. 2017;11:103. DOI: https://doi.org/10.3389/fnhum.2017.00103
39. Labarre-Vila A. Assessment of muscle function in pathology with surface electrode EMG. Rev Neurol (Paris). 2006;162(4):459-65. DOI: https://doi.org/10.1016/s0035-3787(06)75037-8
40. Nielsen JLG, Holmgaard S, Jiang N, Englehart KB, Farina D, Parker PA. Simultaneous and proportional force estimation for multifunction myoelectric prostheses using mirrored bilateral training. IEEE Trans Biomed Eng. 2011;58(3):681-8. DOI: https://doi.org/10.1109/TBME.2010.2068298
41. Li H, Zhao G, Zhou Y, Chen X, Ji Z, Wang L. Relationship of EMG/SMG features and muscle strength level: an exploratory study on tibialis anterior muscles during plantar-flexion among hemiplegia patients. Biomed Eng Online. 2014;13:5. DOI: https://doi.org/10.1186/1475-925X-13-5
