Humeral external rotation handling by using the Bobath concept approach affects trunk extensor muscles electromyography in children with cerebral palsy

C Grazziotin Dos Santos; Aline S Pagnussat; A S Simon; Rodrigo Py; Alexandre Severo do Pinho; Mário B Wagner

doi:10.1016/j.ridd.2014.09.013

Humeral external rotation handling by using the Bobath concept approach affects trunk extensor muscles electromyography in children with cerebral palsy

Res Dev Disabil. 2015 Jan:36C:134-141. doi: 10.1016/j.ridd.2014.09.013. Epub 2014 Oct 20.

Authors

C Grazziotin Dos Santos¹, Aline S Pagnussat², A S Simon³, Rodrigo Py³, Alexandre Severo do Pinho⁴, Mário B Wagner⁵

Affiliations

¹ Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Associação de Assistência à Criança Deficiente (AACD), Porto Alegre RS, Brazil.
² Departamento de Fisioterapia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil. Electronic address: alinespagnussat@gmail.com.
³ Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil.
⁴ Bolsista de desenvolvimento técnico e industrial da Fundação de Amparo à Pesquisa do Rio Grande do Sul (FAPERGS), Brazil.
⁵ Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil.

PMID: 25462474
DOI: 10.1016/j.ridd.2014.09.013

Abstract

This study aimed to investigate the electromyographic activity of cervical and trunk extensors muscles in children with cerebral palsy during two handlings according to the Bobath concept. A crossover trial involving 40 spastic diplegic children was conducted. Electromyography (EMG) was used to measure muscular activity at sitting position (SP), during shoulder internal rotation (IR) and shoulder external rotation (ER) handlings, which were performed using the elbow joint as key point of control. Muscle recordings were performed at the fourth cervical (C4) and at the tenth thoracic (T10) vertebral levels. The Gross Motor Function Classification System (GMFCS) was used to assess whether muscle activity would vary according to different levels of severity. Humeral ER handling induced an increase on EMG signal of trunk extensor muscles at the C4 (P=0.007) and T10 (P<0.001) vertebral levels. No significant effects were observed between SP and humeral IR handling at C4 level; However at T10 region, humeral IR handling induced an increase of EMG signal (P=0.019). Humeral ER resulted in an increase of EMG signal at both levels, suggesting increase of extensor muscle activation. Furthermore, the humeral ER handling caused different responses on EMG signal at T10 vertebra level, according to the GMFCS classification (P=0.017). In summary, an increase of EMG signal was observed during ER handling in both evaluated levels, suggesting an increase of muscle activation. These results indicate that humeral ER handling can be used for diplegic CP children rehabilitation to facilitate cervical and trunk extensor muscles activity in a GMFCS level-dependent manner.

Keywords: Bobath concept; Cerebral palsy; Electromyography; Physiotherapy; Rehabilitation.