Análise eletromiográfica de tronco e membros inferiores de indivíduos com síndrome de Down, encefalopatia crônica não progressiva da infância, deficiência intelectual durante a hipoterapia em comparação com a marcha independente e suas contribuições para o equilíbrio funcional

Abstract

The present study aimed to analyze and compare the muscular electrical activity of the trunk and lower limbs of children with cerebral palsy (CP), Down syndrome (DS) and intellectual disability (ID) during hippotherapy and the independent gait before and after fifteen sessions and their contributions to functional balance. Twenty-four children, both genders, with aged between eight and fifteen years, participated in the study, allocated equally with eight participants in each CP group (10,75 ± 2,49 years), DS (11,88 ± 2,85 years) and ID (11 ± 1,69 years). There were 15 interventions, weekly for 30 minutes, in the hippotherapy program with horse riding equipment specific to each group, blanket without feet supported on stirrups for DS and ID groups and saddle with feet resting on the stirrups for CP group, defined based on a preliminary study. The evaluations of the muscular electrical activity of the trunk and lower limbs were obtained by means of surface electromyography (SEMG) and functional balance using the Pediatric Balance Scale (PBS), before the first and after the fifteenth session (pre and post sessions) during each of the conditions, gait and hippotherapy. For statistical analysis, the software Sigma Stat 3.5® (article 1) and Statistica 10.0® (article 2 and other results). For normality of data was adopted the Shapiro-Wilk test and the Bartlett test for homogeneity of variances. For comparison (intra groups) between hippotherapy and gait (pre and post sessions), the paired t-test for normal and homogeneous data or Wilcoxon for non-normal and non-homogeneous data. For the analysis of multiple variables, the Kruskal-Wallis test followed by the Dunn post-test (cases with non-normal distribution). For functional balance (pre and post sessions), the t-paired test (intra groups) and ANOVA with tests of multiple comparisons of Bonferroni (inter groups). For all results, p<0,05 was determined as statistically significant differences. The results of article 1 demonstrated greater activity of the trunk and lower limb muscles with the blanket equipment without the feet supported in the stirrups for the DS group (H=15,078, p=0,002), as well as in the ID group (H=8,302, p=0,040), while for the CP group it was the saddle with feet supported on the stirrups (H=11,137, p=0,011). In article 2, children with ID showed greater muscular activity of the trunk and lower limbs during gait compared to hippotherapy, with a predominance of the musculature of the lower limbs, regardless of the moment analyzed (p<0,05). During hippotherapy, when analyzing the pre and post sessions, there was an increase in muscle activity after the fifteenth session with significance for the left femoral rectus 10 muscle (p=0,012), while during gait there was a reduction in muscle activation after the fifteenth significant for the right rectus femoris (p=0,017), left anterior tibialis (p=0,028) and right multifidus (p=0,024). For the other results regarding the SEMG of the CP and DS groups, there was greater muscular activity of the trunk and lower limbs during gait compared to the hippotherapy, regardless of the analyzed moment (p<0,05) with the exception of the abdominals for the DS group. When analyzing the pre and post sessions moments during hippotherapy, there was a reduction in muscle activity, mainly in the lower limb muscles, after the fifteenth session for the DS and CP groups, with significance only in the right anterior tibial muscle of children with CP (p=0,042). However, when analyzing the pre and post sessions moments during gait, there was a different behavior between the muscles with increased muscle activation after the fifteenth session for most of the muscles in the DS and CP groups, with significance for the right multifidus (p=0,012) and left (p=0,018) in children with DS. The functional balance results demonstrate an increase in the PBS score after hippotherapy for the three groups and significance for children with ID (p=0,003) and DS (p=0,033) and lower scores for the CP group compared to the DS and ID groups regardless of the pre moments (p=0,003) or post (p=0,002) sessions. From the results, we can conclude that the choice of horse riding equipment used in hippotherapy directly influences with the pattern of muscular activation of the trunk and lower limbs according to the pathological processes of each group of children, being an important aspect to be considered in therapeutic planning. The hippotherapy contributes to the improvement in the functional balance of children with CP, DS and ID after 15 interventions with distinct and specific muscular behaviors during the conditions, independent gait and hippotherapy.