Avaliação da aprendizagem motora e sua correlação com qualidade de vida, participação e funcionalidade em adolescentes com paralisia cerebral: estudo observacional transversal

Abstract

Introduction: Cerebral Palsy (CP) is characterized by impairments in posture and movement, which can limit functional performance and impact participation and quality of life (QoL). Motor learning (ML), defined as the acquisition, retention, and transfer of skills through practice, is essential in rehabilitation, promoting permanent changes in functional capacity and participation across different contexts. Objective: To evaluate ML in adolescents with CP compared to neurotypical adolescents and investigate its correlations with quality of life, participation, and functionality. Methods: The sample consisted of 24 adolescents (12 with CP and 12 neurotypical), matched by sex and age. The Non-Verbal General Intelligence Test - BETA III was used to characterize cognitive functioning in the CP group. The Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS) classified motor impairment and manual ability levels, serving as functionality parameters. ML was assessed using part A of the Trail-Making Test, adapted into a digital version, including environments to evaluate aspects such as skill acquisition, retention, and transfer. QoL was measured using the Kidscreen-27, while participation was assessed through the Participation and Environment Measure for Children and Youth (PEM-CY), considering the contexts of home, school, and community. Statistical analyses were conducted using SPSS 20.0, with the Shapiro-Wilk test applied to verify data normality. Motor performance variables (time and errors) were analyzed using the non-parametric Mann-Whitney test, and QoL comparisons between groups were performed using the independent samples t-test. Correlations between functionality (GMFCS and MACS), participation (school and community), and ML variables (time and errors) were investigated using Spearman’s correlation test. Results: Most participants were male (91.7%). Among adolescents with CP, 53.3% had unilateral spastic CP, and 91.7% were classified at levels I or II of the GMFCS. For MACS, levels were evenly distributed among I, II, and III (33.3% each). In the BETA III, 66.6% showed expected average performance for non-verbal intelligence, while 83.3% displayed below-expected processing speed. Significant increases in execution time were observed across all environments of the adapted Trail-Making Test in the CP group, along with more errors in environments 6 (retention, p=0.045) and 8 (transfer, p=0.008). Participation differences were observed in school (p=0.033) and community contexts (p=0.033), with lower involvement of the CP group in school and community activities. In the CP group, time and errors in specific test environments were correlated with barriers at school (e.g., environment 6A: p=0.018, r=0.666) and in the community (e.g., environment 5A: p=0.031, r=0.621). Errors were negatively correlated with community participation, both in the number of activities performed (p=0.036, r=-0.608) and frequency of participation (p=0.033, r=-0.615). No significant differences were found in QoL between groups, precluding correlational analyses for this variable. Additionally, no correlation was identified between functionality (GMFCS and MACS) and performance in the adapted Trail-Making Test. Conclusion: The results indicate that task complexity and opportunities for participation in school and community contexts directly influence the ML process. Rehabilitation interventions should prioritize both the development of motor skills and the promotion of greater involvement across different life contexts, considering participation as a key rehabilitation goal.