Estimulação precoce para o desenvolvimento neuropsicomotor de crianças com microcefalia: uma revisão sistemática

Canto, Gabrielle Mascarenhas; Avena, Katia de Miranda

Gabrielle Mascarenhas Canto

Study design

Data collection

Data analysis

Manuscript writing

Manuscript revision

Faculdade Zarns, Curso de Medicina, Salvador, BA, Brazil.

https://orcid.org/0000-0001-5627-8528

Katia de Miranda Avena Corresponding author. E-mail: katiaavena@hotmail.com (K. M. Avena)

Study design

Data collection

Data analysis

Manuscript writing

Manuscript revision

Study supervision

Faculdade Zarns, Curso de Medicina, Salvador, BA, Brazil.

https://orcid.org/0000-0002-2179-3893

Corresponding author. E-mail: katiaavena@hotmail.com (K. M. Avena)

Conflict of interests

The authors declare there is no conflict of interests.

Databases	Search strategy
MEDLINE^{^®} via PubMed^{^®}	((child) AND microcephaly) AND Early Intervention, Educational ((child) AND Microcephaly) AND growth & development AND Cognition
Virtual Health Library	(child OR children) AND (microcephaly) AND (rehabilitation) {[Child OR Children] AND Microcephaly AND Early Intervention, Educational}
Cochrane Library	Microcephaly AND Child

Author	Study Design	Sample	Results
Goodman et al.¹⁷17 Goodman JF, Cecil HS, Barker WF. Early intervention with retarded children: some encouraging results. Dev Med Child Neurol. 1984;26:47-55. https://doi.org/10.1111/j.1469-8749.1984.tb04405.x https://doi.org/10.1111/j.1469-8749.1984...	Controlled trial, non-randomized	71 children with intellectual disabilities, at preschool age. Intervention Group: 35 children in hospital; 60.0% female, aged 33.7±9.8 months at first evaluation. Control Group: 36 children, 61.1% female, aged 37.7±10.4 months at the first evaluation.	Before the intervention the children had an average of 55.6±14.2 IQ points, while those in the control group had 59.3±13.0 points. After an average period of 16 months of intervention, there was a gain of 8.1 IQ points among the children in treatment compared to 0.8 points in the control group. An influence of the environment on the children’s growth was noted. It was shown that the stimulations performed by professionals need to be continued by the family. Moreover, individual characteristics have a great interference in the outcome of early stimulation, reinforcing the individuality of the treatment adapted to each case.
DeLuca et al.¹⁴14 DeLuca SC, Wallace DA, Trucks MR, Mukherjee K. A clinical series using intensive neurorehabilitation to promote functional motor and cognitive skills in three girls with CASK mutation. BMC Res Notes. 2017;10:743. https://doi.org/10.1186/s13104-017-3065-z https://doi.org/10.1186/s13104-017-3065-...	Case series	03 children (Child A, 54 months; Child B, 89 months; and Child C, 24 months), all with global developmental delays (limitations in fine/coarse motor skills, speech, communication, social interaction, and cognition).	Child A: Speech was stereotyped and repetitive, was unable to choose shapes, colors, and animals correctly as requested, although able to imitate spoken names. Followed one-step instructions and imitated short sequence behaviors. Child B: Had limited speech, identified colors and some animals, little environmental awareness, exhibited emotional outbursts. He was able to use the pencil, but not to make simple drawings, and the same happened with the use of scissors. Child C: Did not speak and presented fine and gross motor delays, was unable to sit up by himself or to make the transition to sitting in a typical manner for his age; he would not crawl. There was an increase in the development of each child (14 months increase for child A, 39 months for child B, and 20 months for child C), suggesting a good response to intensive therapy aimed at increasing functional skills/independence.
Silva et al. ¹⁶16 Silva YR, Arrais BB, Santos MA, Barata MF, Falcão IV. O passo do frevo potencializando a reabilitação de crianças com Síndrome Congênita do Zika Vírus. Cad Bras Ter Ocup. 2019;27:448-53. https://doi.org/10.4322/2526-8910.ctoRE1265 https://doi.org/10.4322/2526-8910.ctoRE1...	Experience report	30 children with CZVS, aged 9 to 18 months, in Recife, Pernambuco, Brazil.	The children did not sit, hold their heads, or socialize. Some children were already able to maintain cervical tone and made postural changes. The study demonstrated the relevance of the cultural and social context for children with CZVS, highlighting the importance of real, contextual, and interpersonal interactions, facilitating the stimulation of skills such as sitting and standing prone, helping in cervical control and postural changes.
Monteiro et al.²⁰20 Monteiro MG, Tavares Netto AR, Brito PM, Santos AJ, Mattos RM, Wesiolek CC, et al. Efeito em curto prazo de dois protocolos de hidrocinesioterapia em crianças com síndrome congênita associada à infecção do vírus Zika. Acta Fisiatr. 2019;26:186-91. https://doi.org/10.11606/issn.2317-0190.v26i4a168380 https://doi.org/10.11606/issn.2317-0190....	Controlled trial, crossover	16 children diagnosed with CZVS, 58.3% female, aged 23.9±3.97 months, with a birth head circumference of 28.6±1.34 cm, who were being followed at least once a week during the study period.	When analyzing moments T0 and T1, it was observed that after PI there was a significant decrease in the degree of tonus for the extensor muscles of the elbow (p=0.04) and knee (p=0.03). When comparing the interventions (PI versus PII), it was observed that in PI there was a reduction in the degree of tone for the extensor muscles of the elbow (p=0.03). In addition, after PI there was a significant reduction in the ranges of motion for elbow extension (p=0.05) and knee extension (p=0.03). When comparing the interventions (PI versus PII), statistical differences were observed between the ranges of motion for elbow extension (p=0.04), knee extension (p=0.05), and knee flexion (p=0.01). Regarding the level of stress during interventions, none of the 2 protocols promoted significant change.

Amundsen and Evensen ¹⁸18 Amundsen KR, Evensen KA. Physical therapy intervention for a child with congenital zika virus syndrome: a case report. Child Neurol Open. 2020;7:2329048X19896190. https://doi.org/10.1177/2329048X19896190 https://doi.org/10.1177/2329048X19896190...	Case report	01 17-month-old child with CZVS, born in Southeast Asia, at 40 weeks, weighing 2,800 grams, 49 cm long, and a head circumference of 28.5 cm.	All activities were limited due to severe spasticity, and she had no voluntary movements. The child was uncomfortable, she cried a lot, and had difficulty feeding and sleeping. Initial physical therapy sessions were home-based and focused on spasm reduction, good resting positions, and parental support. At one year of age, postural control had already improved, leading to work on postural control of the head. The child showed an increased level of postural ability in the prone position and postural alignment; great gains in head and trunk alignment; improved general mobility and social skills.
Tavares et al. ²¹21 Tavares AB, Sant’Anna Junior A, Borges NC, Santiago HA, Matias Junior I, Menezes-Reis R. Protocolo intensivo de reabilitação para o desenvolvimento neuropsicomotor em uma criança com microcefalia: um estudo de caso. Acta Fisiatr. 2020;27:120-4. https://doi.org/10.11606/issn.2317-0190.v27i2a171245 https://doi.org/10.11606/issn.2317-0190....	Case report	01 child with mild microcephaly, diagnosed at 3 months of age, male, white, 2 years and 3 months old, 83 cm tall and weighing 10.2 kg, born with 35 cm of cephalic perimeter and presenting developmental delay.	He was unable to maintain control of the cervical spine, to manipulate objects and bring his hands to his mouth, would not roll over, had no alignment of head with midline and limbs, and could not perform any position progression. The patient also presented with marked choreoathetosis, with jerky movements, distortions, slowness, and incoordination in execution. At the end of the third week of care, the patient presented good cervical control, sustained for 50 seconds, hardly any falls, keeping the head aligned with the midline, with the body and limbs, brought the hand to the mouth very easily, and actively manipulated objects. In the final evaluation of the fourth week, compared to the previous weeks, the patient showed satisfactory results, with better cervical control, sustained for 1-3 minutes and no falls, showed head alignment with the midline, body and limbs, took his hand to his mouth easily, actively manipulated objects, started to crawl on the bed.
Gama et al., ²²22 Gama GL, Amorim MM, Silva Júnior RA, Santos AC, Assunção PL, Tavares JS, et al. Effect of intensive physiotherapy training for children with congenital zika syndrome: a retrospective cohort study. Arch Phys Med Rehabil. 2021;102:413-22. https://doi.org/10.1016/j.apmr.2020.08.016 https://doi.org/10.1016/j.apmr.2020.08.0...	Retrospective Cohort	7 children, 2 of whom were female and 5 male; 3 of whom were born preterm, with the majority (n=5) from cesarean sections.	The children started stimulation therapy with a mean of 37.0±33.48 points on the GMFM scale. 188 sessions were scheduled, with 27±13.2 absences. The average gain of points in the GMFM questionnaire was 29.4±34.36 points and increased to 66.42±64.91 points. In some children, a stabilization of the gains or even a regression of the global scores was observed after the fourth week of intervention. Child #4 stood out in the improvement of motor function. We noticed a great variation in the GMFM score among the children, which shows the individuality of each one and the non-similar response to the treatment, which may be related to the neurological damage or to the number of sessions. The benefits of this type of therapy have been confirmed, even with severe damage to the central nervous system.

Outcome	No. of participants of the included studies	Quality of evidence (GRADE)
Muscle tone	25	Low
Social interaction	31	Low
Fine and gross motor skills	42	Low
Intelligence quotient	71	Low
Socioemotional and adaptive behavior	54	Low

[1] Corresponding author. E-mail: katiaavena@hotmail.com (K. M. Avena)

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Estimulação precoce para o desenvolvimento neuropsicomotor de crianças com microcefalia: uma revisão sistemática

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