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Padovan Method Of Neurofunctional Reorganization As A Way For

Neurological Recovery In Newborns

Article  in  International Archives of Medicine · January 2015

DOI: 10.3823/1829

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iMedPub Journals International Archives of Medicine 2015
http://journals.imed.pub Section: Pediatrics Vol. 8 No. 230
ISSN: 1755-7682 doi: 10.3823/1829

Padovan Method of Neurofunctional Reorganization

As a Way for Neurological Recovery in Newborns
Original

Lilianny Medeiros Pereira1, 2, Daniele Correa Vileicar2, Samara Bezerra Sales2,

Maria do Socorro Landim Rodrigues Alves1, Jamile de Melo Casado Pereira2,
Lourena Maria Lourenço Alves2, Carla Joseane Rodrigues Figueiredo2, Hermes Melo Teixeira Batista2, 3,
Woneska Rodrigues Pinheiro3, Italla Maria Pinheiro Bezerra3, Luiz Carlos de Abreu3

1  Hospital Municipal São Lucas.

Abstract 2 Estácio Juazeiro do Norte.
3 Design and scientific writing laboratory
of FMABC.
The physiological basis of neurofunctional reorganization in stimula-
ting the nervous system is justified and ratified by the concepts of
Contact information:
neuroplasticity and therefore, its use in neonatology is well indicated.
Lilianny Medeiros Pereira.
Objective: Describe how Neurofunctional reorganization through
Padovan method can contribute to restore neurologic function of [email protected]
newborns and can avoid the need for gastrostomy and shortening
hospital stay.

Method: Descriptive and retrospective study performed in a hospi-

tal at Ceará´s inland, Brazil, through analysis of medical records. 92
patients from the neonatal ICU who suffered perinatal asphyxia and
evolved with neurological disorders were evaluated. Patients received
Keywords
Neurofunctional Reorganization therapy, which is the performance of
Perinatal Asphyxia;
physical and oral exercises that complement each other in order to
Neuroplasticity; Prematurity;
recover lost functions and also prepare the body to acquire functions
Neurofunctional
and capabilities which it has potential for.
Reorganization,
Nervous System.
Results: Eighty-two patients completed the therapy and showed po-
sitive results (89.1%). The main expected outcome was the recovery of
suction and this was achieved in between 8 and 150 days. 48 cases
showed an improvement between 8 and 30 days of treatment (56%).

Conclusions: The Neurofunctional reorganization proposed by Pa-

dovan is effective in the recovery of neurological function of new-
borns, especially the suction, shortening the hospital stay and avoiding
gastrostomy.

© Under License of Creative Commons Attribution 3.0 License This article is available at: www.intarchmed.com and www.medbrary.com 1
 International Archives of Medicine 2015
Section: Pediatrics Vol. 8 No. 230
ISSN: 1755-7682 J doi: 10.3823/1829

Introduction in gas exchange, changes in placental perfusion,

The Neurofunctional Reorganization (NFR), also decreased fetal oxygenation. It can result in mal-
known as "Padovan Method" was developed by formation, airway obstruction, fluid in the lungs,
Beatriz Padovan, speech therapist, in the beginning prematurity and it is strongly associated with high-
of the 70s, based on studies performed by Rudolf risk pregnancy [2].
Steiner about the interrelationship between the The main clinical manifestations of hypoxia are
three human activities of walk-talk-think and the the neurological disorders and they may present a
researches performed by the neurosurgeon Tem- state of hyperreflexia, tremors, changes in posture
ple Fay about organization of the nervous system. and movement, apnea, respiratory failure, abnormal
Physical exercises and re-education of the reflex-ve- swallowing, pupillary and oculomotor responses
getative oral functions (breathing, suction, mastica- also abnormal, tense anterior fontanelle, and even
tion and swallowing) were performed in an attempt convulsive state [3].
to recover lost functions or not yet acquired, but The diagnosis of perinatal hypoxia is based on
within the range of the body's potential. The phy- the following criteria: low Apgar score, below 3 on
sical exercises were applied to the recapitulation of the 5th minute; metabolic acidosis or acidosis mixed
ontogenetic development, acting in the failures and by gases of the umbilical cord blood with blood
development of motor and neurological maturation pH<7.0; neonatal neurological dysfunction and mul-
as a whole and the oral exercises consisted of the tiple organs dysfunction [4].
re-education of the reflex-vegetative oral functions Over the past 20 years, the neonatal mortality
(breathing, suction, mastication and swallowing) [1, has been suffering a reduction, especially in prema-
2]. ture newborns with low birth weight, because of
The method is suitable for all ages, as a curative, advances in intensive care in the Neonatal Intensive
preventive or of maintenance of the nervous sys- Care Units (NICU), improved knowledge of the pro-
tem. However, there is no record in the literature of fessionals involved in the care of these patients, and
its use in newborns with hypoxia. The method can the development of neurostimulation and humani-
be performed by any health professional, with hig- zation techniques of the ICUs (Intensive Care Units).
her education, who has realized the training course. Together these factors lead to an improvement of
This method is applied since 2008 at the Hospital the transfer of affection between parents and new-
Municipal São Lucas, in Juazeiro do Norte, Ceará, in borns, and consequently, a fast recovery [5, 6]. In
an attempt to improve the quality of life of patients general, these patients require being hospitalized
who faced hypoxia. for a long time, with exposure to noxious stimuli
The neonatal hypoxia is the most common cause such as pain, stress, lights, noise, invasive procedu-
of neurological damage in newborns and it results res and temperature variations of the environment.
in impairment of neurodevelopment. Usually occurs Besides, they remain separated from their parents
in the period before birth. Affects indiscriminately for a long period [6, 12].
the full term and premature newborn, and contribu- Advances in research have helped in improving
tes significantly to perinatal and neonatal morbidity the quality of life of patients facing damage cau-
and mortality [1]. sed by failing oxygenation of the brain. Among the
The incidence varies around 1.5% depending on issues discussed by experts there is the neuroplasti-
the criteria used and the gestational age. The peri- city, nervous system ability to designate a particular
natal asphyxia is caused by the decrease on the flow cell, different function than what was originally pro-
of the umbilical circulation, resulting in alterations grammed to be performed replacing the function

2 This article is available at: www.intarchmed.com and www.medbrary.com

 International Archives of Medicine 2015
Section: Pediatrics Vol. 8 No. 230
ISSN: 1755-7682 doi: 10.3823/1829

of other damaged cell7. That is, the ability to adapt professionals of the institution who are responsible
and dynamic reorganization of the nervous system for implementing and monitoring the evolution of
when facing environmental changes [8]. hypoxic newborns admitted to an intensive care unit
This neural reorganization is the primary goal of of a hospital located in the region of Cariri, Ceará,
neural recovery to modulate recovery of function Brazil.
and may be influenced by experience, behavior, The study included medical records of patients
practice of tasks and in response to brain injuries [9]. admitted between 2008 and 2015 and its objective
It has been observed that the learning of a spe- is to evaluate the neurological recovery of newborns
cific activity and its repetitive practice induces dy- who received the Padovan method of neurofunctio-
namic and plastic changes in the central nervous nal reorganization. The patients received body
system (CNS). This occurs because the motor trai- exercises and re-education of the reflex-vegetative
ning induces neurogenesis, synaptogenesis, angio- oral functions (breathing, suction, mastication and
genesis, pre and post synaptic modulation among swallowing).
others, and all these events result in improved re- The method was applied to every newborn with
covery of motor disorders related to hypoxic injury alterations in their neurological examination and/or
[7, 13]. presenting difficulty in sucking, after explaining to
Up to 2 years of age a person has greater poten- parents and getting the Informed Consent signed
tial for neuroplasticity, essential for a normal develo- by them. The therapy was initiated from the time
pment of the nervous system, called critical period. when the newborn was found to be stable and it
The processes involved include synaptogenesis, axo- was performed once a day, 5 times per week. Even
nal plasticity or ontogenetic. However, an environ- if using a ventilator, the patients received the the-
ment rich in stimuli is essential for the acquisition of rapy as long as they were hemodynamically stable,
multiple cerebral capabilities, since they provide the and with more limited exercises. The child received
excitation required for modification of the neural evaluation through neurological examination conti-
circuits [10]. nually, always comparing it with the previous exa-
Current studies report that neural reorganiza- mination and describing the improvement.
tion can occur and facilitate the recovery of neural
function. Studies confirm that this reorganization
can be facilitated by incorporating repetitive activity, Results
practice of specific tasks, sensory training and men- From 2008 until July 2015, 92 newborns were
tal practice, all integrated to rehabilitation strategies looked after using a therapy called neurofunctional
[10, 11]. reorganization by Padovan method, being prematu-
Therefore, the present study aims to describe re or full term, with weights ranging from 780g to
how the Neurofunctional reorganization by Padovan 3.800g. As an indication for the therapy, there were
method can help to restore neurological function in 31 cases for early stimulation of premature (33.6%),
newborns and can avoid the need for gastrostomy one case of congenital facial paralysis (1.08%), 34
and shortening the hospital stay. cases of change in neurological examination inclu-
ding absence or deficit of suction by asphyxiation
(36.9%), eight cases of respiratory distress impai-
Methods ring coordination for sucking (8.6%), eight cases of
It is a descriptive and retrospective study performed laryngeal dysfunction by malformation or prolon-
from the analysis of records conducted by three ged mechanical ventilation (8.6%), 2 cases of apnea

© Under License of Creative Commons Attribution 3.0 License 3

 International Archives of Medicine 2015
Section: Pediatrics Vol. 8 No. 230
ISSN: 1755-7682 J doi: 10.3823/1829

by immaturity (2.1%) and eight cases of neurological Despite the Padovan Method of Neurofunctional
changes by syndromes (8.6%). Reorganization exists and is being used since the
The age for onset of the therapy ranged from 70's, there are no reports in the literature of its
two days old to 102 days of life. Seven patients use in patients with perinatal hypoxia. The difficul-
died during hospitalization due to complications ty in eating is the main factor that interferes with
from sepsis, two patients were transferred to other comorbidities of the patient, since it is responsible
hospitals, one to undergo a tracheostomy due to for bronchoaspirations and recurrent pneumonia,
congenital paralysis of the vocal cords and the which are the leading cause of death [6]. With the
other for surgical procedure of branchial cyst. 82 therapy, all patients were discharged with good
patients completed the therapy with appropriate coordination of sucking, swallowing and breathing.
conditions of discharge (89.1%) and one remains These patients remain being monitored in the hos-
in treatment. pital outpatient care system.
The therapy time ranged from two days to five The foundations of Padovan method of applying
months and 12 patients had a response in less than exercises through primitive movements, proper of
seven days (14.6%), 36 between seven days and ontogenetic development and recognizable by the
less than a month (43.9%), 18 between one and central nervous system is ratified by the current stu-
two months (21.9%). Three patients were treated dies about the neural plasticity [1].
for more than two months (3.6%) and in 13 cases it If the method has a good response in adults and
was not possible to determine the length of therapy elderly, where neurodegeneration has already star-
from the medical records. Among the eight children ted, the chance of excellent responses in newborns
with syndromes we had a case of Treacher-Collins is very high, since the neural plasticity is at its hig-
syndrome, a case of Down syndrome, two cases of hest during childhood and the stimulus is critical to
fetal alcohol syndrome a Moebius Syndrome, one the acquisition of brain skills, since they provide the
thoracic dysplasia and two syndromes to clarify. excitation required for permanent modification of
neural circuits [10].
In the present study, there is no control group to
Discussion compare this therapy with the others already exis-
The incidence of neurological impairment of new- ting, as the institution has standardized the Padovan
borns is still high in our country; it is due to prenatal, method to be used whenever indicated. However,
perinatal or post-neonatal events, prolonging their we can evaluate the case of the first patient to recei-
hospital stay [2]. ve the therapy who have had hypoxia and the first
In addition to the neurological deficit resulting case of children with fetal alcohol syndrome, who
from hypoxic-ischemic encephalopathy that accom- were already in the hospital for three months in
panies the child for the whole life, requiring multi- traditional speech therapy without sucking respon-
disciplinary care, the absence of suction in the early se, with indication for a gastrostomy, who were in
days is a difficulty for hospital discharge, leading to prolonged hospitalization, and who had a positive
prolonged hospital stay, increasing the risk of noso- response after starting the Padovan method, in 15
comial infection [4, 5]. According to our results, the days and three weeks, respectively.
therapy based in the Padovan techniques shortened From these cases the therapy has become pre-
the hospital stay and avoided gastrostomy, palliative maturely used as soon as they noticed change in
procedure of feeding for discharge, which is not the neurological examination of patients. One of
free from complications. the babies with laryngomalacia presented suction,

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 International Archives of Medicine 2015
Section: Pediatrics Vol. 8 No. 230
ISSN: 1755-7682 doi: 10.3823/1829

however, due to a dysfunction, the baby could not ge of hospital stay, after providing stimulus to the
coordinate it with breathing. In this case the therapy nervous system and new ways to perform their lost
was also initiated on a trial basis, as there was no functions were created.
improvement with respiratory physiotherapy. The
baby evolved positively after the imposition of Pa-
dovan therapy with disappearance of stridor and Conclusion
respiratory distress, allowing the child to oral feed The Neurofunctional reorganization proposed by
on the seventh day. Padovan was effective in the recovery of neurolo-
In 2013 the therapy was initiated as an early sti- gical functions of newborns, especially the suction,
mulation in premature infants, with treatment las- shortening the hospital stay and avoiding gastros-
ting an average of 30 days, a period equivalent to tomy.
the weight gain of these children.
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© Under License of Creative Commons Attribution 3.0 License 5

 International Archives of Medicine 2015
Section: Pediatrics Vol. 8 No. 230
ISSN: 1755-7682 J doi: 10.3823/1829

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