Efeitos da estimulação sensorial vestibular no desenvolvimento neuromotor por meio de posicionamento em rede de balanço em prematuros tardios: ensaio clínico randomizado

Abstract

Introduction: in children with impaired development and premature infants, it is common to observe sensory deficits, and therapies with sensory intervention can contribute to the improvement of neuropsychomotor development. Objectives: this master's thesis had two objectives: 1) to map the effect of sensory integration therapies on child development; to evaluate the effects of vestibular sensory stimulation through the “Hammock” positioning on neuropsychomotor development in late preterm infants. Methods: For the first objective, a scoping review was carried out based on the Joanna Briggs Institute methodology, configured by the acronym P (Participant), represented by individuals with pediatric care (below 14 years old - 13 years, 11 months and 29 days) , acronym C (Concept), effect of sensory integration therapies, is the acronym C (Context), highlighted by the period of child development. For the second objective, a single-center, single-blind, comparative Randomized Clinical Trial (RCT) was carried out from October 2021 to March 2022. Newborns were randomly allocated into two groups: 1) vestibular sensory stimulation through positioning " Hammock” (GVA); 2) conventional vestibular sensory stimulation (GVT) method. Neuropsychomotor development was evaluated using the General Movement Assessment (GM), Adapted Brazelton Scale and the Neonatal Facial Activity Coding System (NFCS) at 4 time points: (1: baseline; 2: after the first intervention; 3: before last intervention; 4: after the last intervention). Results: In the first study, 5018 studies were identified, and 10 were included in the final qualitative synthesis. Of these, most applied Sensor-Based Sensory Integration Therapy and Ayres Sensory Integration to children with sensory deficits with significantly positive effects. In study 2, an improvement in the sleep and wakefulness index was observed in the GVA between moments 4 and 1 (p = 0.0001), 4 and 2 (p = 0.0001), 3 and 1 (p = 0.0001) and 3 and 2 (p = 0.0001). Improvement was also observed in GVT between moments 4 and 1 (p = 0.0001), 4 and 2 (p = 0.02), 3 and 1 (p = 0.03), and 3 and 2 (p = 0.04). For the GM outcome, an improvement in the pattern of spontaneous movement in the GVA was observed after the intervention (p = 0.008) and a reduction in those who presented abnormal repertoires after the intervention (p = 0.01). In the GVT, the same behavior was observed, improvement of the normal pattern after the intervention (p = 0.04) and reduction of abnormal patterns after the intervention (p = 0.05). Conclusion: The positive effects of the use of Sensory Integration Therapy Based on Sensors and Sensory Integration of Ayres have been demonstrated in the treatment of the development of children, mainly, those diagnosed with Autistic Spectrum, which contributes to a more reliable and efficient treatment. choice of therapy. reliable, which helps in decision making and applicability in clinical practice. In addition, we observed that vestibular sensory stimulationthrough the “Hammock” positioning has positive effects on sleep/wake quality and neuromotor development of late preterm infants in a similar way to the conventional group.