Aspectos motores, de comunicação, sono-vigília e melatonina na paralisia cerebral
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Data
2017-04-27
Autores
Santos, Janaina Senhorini dos [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
A paralisia cerebral (PC) engloba um conjunto de alterações de tônus, postura e movimentos que resulta em limitações funcionais em diferentes níveis, atribuídas a quadros não progressivos que ocorreram no desenvolvimento fetal ou no cérebro ainda imaturo da criança. Dentre as características deste quadro encontram-se também queixas de distúrbios de sono, com causas ainda não totalmente elucidadas e que possivelmente prejudicam o desempenho motor e cognitivo nesta população. Apesar da importância, ainda não está claro o quanto aspectos da comunicação e do desenvolvimento motor poderiam estar comprometidos pela presença de distúrbios de sono na PC. Dentre as possíveis causas para distúrbios de sono em diversos quadros patológicos está o déficit na produção do hormônio melatonina, fato que também ainda não foi investigado nessa população. O objetivo deste estudo foi caracterizar e correlacionar aspectos motores, de comunicação, os distúrbios de sono e o conteúdo de melatonina em indivíduos com PC. Para isso foram avaliados 33 indivíduos com PC, de 2 a 15 anos de idade, classificados pelos sistemas de classificação de função motora grossa (GMFCS), e de função de comunicação (CFCS) e por questionários de sono. O teor de melatonina foi analisado por kits comerciais ELISA. Os resultados indicaram que: 9% dos indivíduos com PC nível I; 18% nível II; 24,5% nível III; 15% nível IV e 33,5% nível V no GMFCS. 30,5% dos indivíduos com PC apresentaram nível I; 12% nível II, 12% nível III; 0% nível IV e 45,5% nível V em função de comunicação. Os distúrbios do sono foram encontrados em 78% das crianças com PC. O grupo PC apresentou menor conteúdo de melatonina noturna que os controles. As análises de correlação mostraram que quanto maior a deficiência motora, maior o comprometimento da comunicação e piores os distúrbios de sono. Além disso, quanto maior o índice da escala de distúrbio de sono pior o desempenho funcional motor em relação ao que era esperado para cada indivíduo. Todas as crianças do grupo PC que apresentaram distúrbios de sono apresentaram também déficits no conteúdo de melatonina. Os resultados permitem concluir que houve uma relação direta entre as características motoras e de comunicação, entre os baixos níveis de melatonina e os distúrbios de sono e entre os distúrbios de sono e as habilidades motoras na PC.
Cerebral palsy (CP) encompasses a set of changes in tone, posture and movements resulting in functional limitations at different levels attributed to non-progressive frames that occurred in the fetal development or the child´s still immature brain. Among the characteristics of this picture are also complaints of sleep disorders, with causes not yet fully elucidated and possibly impair motor and cognitive performance in this population, despite the importance, it is still not clear how much aspects of communication and motor development could be compromised by the presence of sleep disorders in the CP. Among the possible causes for sleep disorders in several pathological conditions is the deficit in the production of the hormone melatonin, a fact that has not yet been investigated in this population. The objective of this study was to characterize and correlate motor, communication, sleep disorders and melatonin content in individuals with CP. For this purpose, 33 individuals with CP, 2 to 15 years of age, classified by gross motor function classification (GMFCS), and communication function (CFCS) and sleep questionnaires were evaluated. The melatonin content was analyzed by commercial ELISA kits. The results indicated that: 9% of individuals with CP level I; 18% level II; 24,5% level III; 15% level IV and 33,5% level V in GMFCS. 30,5% of individuals with CP had Level I; 12% level II; 12% level III; 0% level IV and 45,5% level V as function of communication. Sleep disturbances were found in 78% of children with CP. The CP group had lower nocturnal melatonin content than controls. Correlation analyzes showed that the greater the motor impairment the greater the impairment of communication and the worse the sleep disorders. In addition, the higher the index of sleep disturbance scale the worse the motor functional performance compared to what was expected for each individual. All children in the CP group who presents sleep disorders also presented deficits in melatonin content. The results allow us to conclude that there was direct relationship between motor and communication characteristics, between low levels of melatonin and sleep disorders, and between sleep disorders and motor skills in CP.
Cerebral palsy (CP) encompasses a set of changes in tone, posture and movements resulting in functional limitations at different levels attributed to non-progressive frames that occurred in the fetal development or the child´s still immature brain. Among the characteristics of this picture are also complaints of sleep disorders, with causes not yet fully elucidated and possibly impair motor and cognitive performance in this population, despite the importance, it is still not clear how much aspects of communication and motor development could be compromised by the presence of sleep disorders in the CP. Among the possible causes for sleep disorders in several pathological conditions is the deficit in the production of the hormone melatonin, a fact that has not yet been investigated in this population. The objective of this study was to characterize and correlate motor, communication, sleep disorders and melatonin content in individuals with CP. For this purpose, 33 individuals with CP, 2 to 15 years of age, classified by gross motor function classification (GMFCS), and communication function (CFCS) and sleep questionnaires were evaluated. The melatonin content was analyzed by commercial ELISA kits. The results indicated that: 9% of individuals with CP level I; 18% level II; 24,5% level III; 15% level IV and 33,5% level V in GMFCS. 30,5% of individuals with CP had Level I; 12% level II; 12% level III; 0% level IV and 45,5% level V as function of communication. Sleep disturbances were found in 78% of children with CP. The CP group had lower nocturnal melatonin content than controls. Correlation analyzes showed that the greater the motor impairment the greater the impairment of communication and the worse the sleep disorders. In addition, the higher the index of sleep disturbance scale the worse the motor functional performance compared to what was expected for each individual. All children in the CP group who presents sleep disorders also presented deficits in melatonin content. The results allow us to conclude that there was direct relationship between motor and communication characteristics, between low levels of melatonin and sleep disorders, and between sleep disorders and motor skills in CP.
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Palavras-chave
Paralisia cerebral, Função motora, Comunicação, Sono, Melatonina, Cerebral palsy, Motor function, Communication, Sleep, Melatonin