RESUMO Objetivo: Validar o instrumento de avaliação do membro superior, Shriners Hospital Upper Extremity Evaluation (SHUEE), para indivíduos com paralisia cerebral hemiplégica da população brasileira. Métodos: Estudo de validação no qual foi realizada tradução e adaptação cultural do manual e do instrumento. As propriedades psicométricas avaliadas foram confiabilidade e validade convergente. A confiabilidade foi determinada através da consistência interna (coeficiente α de Cronbach), efeito teto e chão, sensibilidade à mudança e concordância intra e interobservador. A validade convergente foi realizada utilizando-se o Pediatric Motor Activity Log, a escala de autocuidados do Pediatric Evaluation of Disability Inventory e o Manual Ability Classification System. Resultados: Foram avaliados 21 indivíduos com paralisia cerebral hemiplégica com idade média de 8,7±4,0 anos. Após a tradução do instrumento, não houve necessidade de adaptação cultural. O coeficiente α de Cronbach total foi de 0,887 (intervalo de confiança de 95% [IC95%] 0,745-0,970). A sensibilidade à mudança foi calculada em cinco indivíduos que realizaram aplicação de Toxina Botulínica tipo A e fisioterapia, apresentando diferença significativa entre a avaliação pré e pós-tratamento na Análise Funcional Espontânea e Análise Posicional Dinâmica. A validade convergente mostrou correlação significativa da Análise Funcional Espontânea e Análise Posicional Dinâmica com as escalas avaliadas. Todos os itens do SHUEE apresentaram concordâncias fortes, tanto na avaliação intra quanto na interobservador. Conclusões: A versão brasileira do SHUEE demonstrou um bom desempenho em relação à confiabilidade e validade convergente, sugerindo ser uma ferramenta adequada e confiável para os indivíduos com paralisia cerebral hemiplégica na população brasileira.

ABSTRACT Objective: To validate the upper limb assessments tool, Shriners Hospital Upper Extremity Evaluation (SHUEE), for individuals with hemiplegic cerebral palsy in the Brazilian population. Methods: Validation study to translate and culturally adapt the Manual and the instrument. The psychometric properties evaluated were reliability and convergent validity. Reliability was determined by internal consistency (Cronbach’s α coefficient), ceiling and floor effect, sensitivity to changes, and intra- and interobserver agreement. Convergent validity was performed using the Pediatric Motor Activity Log, the self-care scale of the Pediatric Evaluation of Disability Inventory, and the Manual Ability Classification System. Results: We evaluated 21 individuals with hemiplegic cerebral palsy, with a mean age of 8.7±4.0 years. After the instrument was translated, there was no need for cultural adaptation. The total Cronbach’s α coefficient was 0.887 (95% confidence interval [95%CI] 0.745-0.970). We calculated sensitivity to changes in five subjects who underwent treatment with Botulinum Toxin Type A and physical therapy, with a significant difference between pre- and post-treatment evaluations in the Spontaneous Functional Analysis and Dynamic Positional Analysis. Convergent validity showed a significant correlation of the Spontaneous Functional Analysis and Dynamic Positional Analysis with the scales evaluated. All items of SHUEE presented high intra- and interobserver agreement. Conclusions: The results revealed that the Brazilian version of the SHUEE demonstrated good reliability and convergent validity, suggesting that it is an adequate and reliable tool for individuals with hemiplegic cerebral palsy in the Brazilian population.

RESUMO Objetivo: Identificar critérios de seleção para a rizotomia dorsal seletiva (RDS) na paralisia cerebral (PC), analisar os instrumentos de avaliação e descrever as características da fisioterapia nos protocolos pós-operatórios. Fontes de dados: Revisão do tipo integrativa nas bases de dados SciELO, PEDro, Cochrane Library e PubMed. Os termos em português e inglês “paralisia cerebral”, “rizotomia dorsal seletiva” e “fisioterapia” foram utilizados na busca. Os critérios de inclusão foram: artigos que arrolaram indivíduos com PC, que realizaram fisioterapia nos protocolos de RDS e que descreviam características desses protocolos. Foram excluídos artigos de revisão da literatura e não houve restrição de período de publicação. Síntese dos dados: Incluíram-se 18 estudos, sendo a maioria coortes prospectivas, com acompanhamento dos pacientes de oito meses a dez anos. Os instrumentos das avaliações contemplam, na maior parte dos trabalhos, os domínios de funções e estruturas corporais e atividade. O percentual de secção das raízes posteriores foi próximo a 50%. A principal indicação para a RDS incluiu deambuladores com diplegia espástica, que preenchiam os seguintes critérios: espasticidade que interfere com a mobilidade, boa força muscular de membros inferiores e tronco, sem deformidades ortopédicas, distonia, ataxia ou atetose e boa função cognitiva. A fisioterapia é parte integrante dos protocolos de tratamento com RDS, devendo ser intensiva, específica e enfatizada principalmente no primeiro ano. Conclusões: Os estudos salientam a importância da seleção adequada dos pacientes para o sucesso dos resultados. A fisioterapia é intensiva e de longa duração, devendo necessariamente ter estratégias para modificar o antigo padrão motor.

ABSTRACT Objective: To identify selection criteria for selective dorsal rhizotomy (SDR) in cerebral palsy, to analyze the instruments used for evaluation, and to describe the characteristics of physical therapy in postoperative protocols. Data sources: Integrative review performed in the following databases: SciELO, PEDro, Cochrane Library, and PubMed. The terms in both Portuguese and English for “cerebral palsy”, “selective dorsal rhizotomy”, and “physical therapy” were used in the search. Studies whose samples enrolled individuals with cerebral palsy who had attended physical therapy sessions for selective dorsal rhizotomy according to protocols and describing such protocols’ characteristics were included. Literature reviews were excluded and there was no restriction as to period of publication. Data synthesis: Eighteen papers were selected, most of them being prospective cohort studies with eight-month to ten-year follow-ups. In most studies, the instruments of assessment encompassed the domains of functions, body structure, and activity. The percentage of posterior root sections was close to 50%. Primary indications for SDR included ambulatory spastic diplegia, presence of spasticity that interfered with mobility, good strength of lower limbs and trunk muscles, no musculoskeletal deformities, dystonia, ataxia or athetosis, and good cognitive function. Postoperative physical therapy is part of SDR treatment protocols and should be intensive and specific, being given special emphasis in the first year. Conclusions: The studies underline the importance of appropriate patient selection to obatin success in the SDR. Postoperative physical therapy should be intensive and long-term, and must necessarily include strategies to modify the patient’s former motor pattern.

ABSTRACT Objective: To verify the correlation between visual gait analysis (VGA) by the Edinburgh visual gait score (EVGS) and functional aspects using the Timed Up and Go Test (TUG) and Gross Motor Function Classification System (GMFCS) in individuals with cerebral palsy (CP). Methods: Retrospective cross sectional study of 35 patients with CP. The mean age 12.61 years old, 94.3% were spastic; 34.4% hemiplegic, 54.3% diplegic, 11.4% triplegic; 45.7% were level II GMFCS, 42.9% level I, 5.7% level III and 5.7% level IV. VGA was analyzed by the Edinburgh visual gait score (EVGS), functional mobility was assessed by TUG and functionality through GMFCS. The Spearman correlation was used for statistical analysis. Results: The mean EVGS score was 18.97. The mean TUG was 13.71sec. EVGS showed moderate correlation with TUG (r=0.46, p=0.03) and GMFCS (r=0.45, p=0.00). Conclusion: Worse VGA scores correlate to worse functionality and mobility performance. Due to the observed correlation, it is possible to assert that VGA is a useful tool on evaluation of CP patients. Level of Evidence III, Retrospective Comparative Study.

OBJECTIVE: To demonstrate the use of the tool for evaluation of spastic upper limb SHUEE (Shriners Hospital Upper Extremity Evaluation) in the evaluation of upper limb in cerebral palsy (CP) and its ability to detect changes after surgical treatment of identified deformities. METHODS: 19 patients with spastic hemiplegic CP had their upper limb evaluated by SHUEE. Five patients underwent surgical treatment of deformities detected and performed the test at one year postoperatively. RESULTS: The mean age was 9.02 years old; 18 patients were classified as level I GMFCS and one patient as level II. At baseline, the mean spontaneous functional analysis was 59.01; dynamic positional analysis was 58.05 and grasp-and-release function, was 91.21. In the postoperative period the scores were, respectively, 65.73, 69.62 and 100, showing an improvement of 3.5% in the spontaneous functional analysis and of 44.8% in dynamic positional analysis. CONCLUSIONS: SHUEE is a tool for evaluation of spastic upper limb in cerebral palsy that helps in the specific diagnosis of deformities, indication of treatment and objective detection of results after surgical treatment. Level of Evidence IV, Case Series.

Objetivo:Relatar a experiência da aplicação de toxina botulínica A (TBA) em uma série de pacientes com paralisia cerebral (PC) GMFCS nível V.Métodos:Estudo retrospectivo de série de casos, 33 pacientes com PC GMFCS nível V que receberam 89 sessões para aplicação de TBA (84 Botox® e cinco outras apresentações), em busca basicamente de efeitos adversos.Resultados:O número médio de sessões para aplicação por paciente foi três e a idade média em cada injeção foi 4 + 6 anos (1,6-13 anos). Os músculos mais frequentemente injetados foram gastrocnêmios, isquiotibiais, adutores do quadril, bíceps braquial e flexores dos dedos. A dose média total foi 193 U e a dose média por peso foi 12,5 U/k. Somente um paciente recebeu anestesia para as injeções e sedação não foi usada em qualquer caso. Não foram observados efeitos adversos locais ou sistêmicos dentro de seguimento mínimo de um mês.Conclusão:A ausência de efeitos adversos em nossa série está provavelmente relacionada ao uso de doses baixas e ao não emprego de sedação ou anestesia. De acordo com nossos dados, a TBA pode ser usada de forma segura em pacientes com PC GMFCS nível V, em doses baixas e preferencialmente sem sedação ou anestesia.

Objective:To report on the experience of injections of botulinum toxin A (BTA) in a series of patients with cerebral palsy of Gross Motor Function Classification System (GMFCS) level V.Methods:This was a retrospective case series study on 33 patients with cerebral palsy of GMFCS level V who received 89 sessions of BTA application (of which 84 were Botox® and five were other presentations), in which the basic aim was to look for adverse effects.Results:The mean number of application sessions per patient was three, and the mean age at the time of each injection was 4 + 6 years (range: 1.6–13 years). The muscles that most frequently received injections were the gastrocnemius, hamstrings, hip adductors, biceps brachii and finger flexors. The mean total dose was 193 U and the mean dose per weight was 12.5 U/kg. Only one patient received anesthesia for the injections and no sedation was used in any case. No local or systemic adverse effects were observed within the minimum follow-up of one month.Conclusion:The absence of adverse effects in our series was probably related to the use of low doses and absence of sedation or anesthesia. According to our data, BTA can be safely used for patients with cerebral palsy of GMFCS level V, using low doses and preferably without sedation or anesthesia.