Avaliação da percepção e da representação do corpo em crianças com Paralisia Cerebral Hemiplégica

Abstract

Body awareness or perception of ones own body is a fundamental process for controlling the action. Body knowledge is an egocentric reference that allows us to act in our surroundings. Recent studies demonstrate that the processing of knowledge related to the body include several representations and that there are at least three different types of body representation: Body Schema (BS), Visuospatial Description of Body Structure (VDBS) and Body Image (BI). We described a neuropsychological and a neuroanatomical processing model of body perception and representation. These models were used in the classification of different levels of body representation. Perceptual and sensorial impairment after brain lesion in adults have been well addressed by the scientific literature. However, similar impairment in children has not received the same attention. Several studies have shown that somatosensory or percept cognitive damage harms the recovery of hemiplegic adult patients. Nevertheless, we could not find similar reports involving children, nor instruments created in order to undergo such evaluation. Objectives: Our primary objective was to elaborate and adapt a neuropsychological instrument for the evaluation of body perception and representation in children with hemiplegic cerebral palsy (HCP). Additionally, we used the instrument we developed to investigate if children with HCP were impaired in the different forms of body representation, when compared to children with normal development. Methods: We had a sample of 114 children, being 65 in the control group (m = 100.12 months, sd = 19.726 months), 24 in the group with right hemiplegia (m = 104.79 months, sd = 17.876 months) and 25 in the group with left hemiplegia (m = 99.24 months, sd = 21.462 months). The neuropsychological and neuroanatomical models of body representation were used as criterion for classifying the tests, which were applied to a group of children with HCP and to a control group. Results: The instrument we elaborated was adequate to the group with HCP. Results revealed the existence of impairment in body perception and representation in children with HCP in the different levels of body representation: BS, VDBS and BI. Conclusion: We corroborated the hypothesis that lesion on immature brains, such as cerebral palsy, is related to impairment in the different types of body perception and representation. Furthermore, diagnosis of disorders of body perception and representation has immediate implications in the devising of rehabilitation strategies.