Abordagens fisioterapêuticas no tratamento de deformidades em crianças com paralisia cerebral: uma revisão sistemática

Abstract

Introduction: Cerebral palsy is a group of permanent and non-progressive neurological disorders of the developing brain. This pathology can generate several motor and postural deficits causing secondary musculoskeletal disorders such as deformities that are changes in the bone and joint structures, directly impacting on mobility and functionality. Objectives: To identify the main physiotherapeutic approaches used in the treatment of deformities in children with cerebral palsy. Methodology: This systematic review has a descriptive and qualitative character and had the protocol registered in the PROSPERO platform with Registration Code CRD420251035416. As eligibility criteria, randomized controlled trials published in the last 10 years were included, available in full and free of charge, in English, Portuguese and Spanish. As exclusion criteria were excluded studies with the elderly or adult population, with other neurological disorders, published before 2015, do not address physiotherapy as an intervention or do not evaluate the outcomes of interest. Primary outcomes: motor function and spasticity. Secondary outcomes: scoliosis degrees and hip dislocation. Search database: COCHRANE, EMBASE, LILACS and PubMed, in addition to the Forward Citation Searching technique. The main authors collected the articles and extracted the main data to describe the approaches used, as well as detailing the characteristics of the identified population. RoB 2.0 was used to assess the risk of bias. Heterogeneity was identified with the use of RevMan 5.4 platform. To evaluate the certainty of evidence, GRADEpro GDT was applied. Results: Nine studies were included, where 5 addressed deformity in the ankle and foot, 2 scoliosis and 2 progressive hip dislocation. In total, there were 356 participants. 3 studies showed low risk of bias. According to the graduation of the outcomes, 3 had very low evidence certainty and 1 was low. Discussion: Among the findings, most studies do not point to a significant difference between conventional physiotherapy and experiments performed, but they were safe when associated with traditional rehabilitation. Final considerations: It was possible to describe the approaches used for deformities, such as kinesio taping for lower limbs, the use of assistive technology for scoliosis and progressive hip dislocation beyond conventional physiotherapy. However, the studies presented serious methodological flaws and therefore new research with this population is necessary with greater methodological rigor, time of measurement of outcomes and quantitative analysis in order to establish the real effectiveness of these physiotherapeutic techniques.