Effect of Intensive Physiotherapy Training for Children With Congenital Zika Syndrome: A Retrospective Cohort Study

Published:September 29, 2020DOI:



      To investigate the effect of intensive physiotherapy training on the motor function of children with congenital Zika syndrome (CZS).


      A retrospective cohort study.


      A support center for children with microcephaly.


      Children (N=7) aged 14 to 18 months old who were diagnosed with CZS and previously monitored more than 1 year.


      A 2-stage protocol repeated uninterruptedly for 1 year. In the first stage, the children were submitted to 1 hour of conventional physiotherapy and 1 hour of suit therapy 5 times a week for 4 weeks. The second stage consisted of 1 hour of suit therapy 3 times a week for 2 weeks.

      Main Outcome Measures

      Gross motor function measure (GMFM) and body weight.


      Six evaluations were conducted approximately 3 months apart. An increase in the overall GMFM score was observed between the first and second (P=.046), first and third (P=.018), first and fourth (P=.018), first and fifth (P=.043), and first and sixth evaluations (P=.018). Differences in the scores of the individual GMFM dimensions were found only for dimension A (lying and rolling) between the first and fourth evaluations (P=.027) and for dimension B (sitting) between the first and third (P=.018), first and fourth (P=.046), and first and sixth evaluations (P=.027). No difference was found in body weight between the first and sixth evaluations (P=.009). During follow-up, only 1 child required hospitalization, and another had increased irritability.


      Children with CZS were able to perform 2 hours of motor physiotherapy daily with no serious complications, resulting in an increase or stabilization in GMFM scores.


      List of abbreviations:

      CZS (congenital Zika syndrome), GMFM (gross motor function measure)
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        • Oliveira Melo A.S.
        • Malinger G.
        • Ximenes R.
        • Szejnfeld P.O.
        • Alves Sampaio S.
        • Bispo de Filippis A.M.
        Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg?.
        Ultrasound Obstet Gynecol. 2016; 47: 6-7
        • Eickmann S.H.
        • Carvalho M.D.
        • Ramos R.C.
        • Rocha M.A.
        • Linden V.
        • Silva P.F.
        [Zika virus congenital syndrome] [Portuguese].
        Cad Saude Publica. 2016; 32 (S0102-311X2016000700601)
        • Melo A.S.
        • Aguiar R.S.
        • Amorim M.M.
        • et al.
        Congenital Zika virus infection: beyond neonatal microcephaly.
        JAMA Neurol. 2016; 73: 1407-1416
        • Moura da Silva A.A.
        • Ganz J.S.
        • Sousa P.D.
        • et al.
        Early growth and neurologic outcomes of infants with probable congenital Zika virus syndrome.
        articles from emerging infectious diseases. 2016; 22: 1953-1956
        • Chimelli L.
        • Melo A.S.O.
        • Avvad-Portari E.
        • et al.
        The spectrum of neuropathological changes associated with congenital Zika virus infection.
        Acta Neuropathol. 2017; 133: 983-999
        • Szejnfeld P.S.O.
        • Levine D.
        • Melo A.S.
        • et al.
        Congenital brain abnormalities and Zika virus: what the radiologist can expect to see prenatally and postnatally.
        Radiology. 2016; 281: 203-218
        • Levine D.
        • Jani J.C.
        • Castro-Aragon I.
        • Cannie M.
        How does imaging of congenital Zika compare with imaging of other TORCH infections?.
        Radiology. 2017; 285: 744-761
        • de Fatima Viana Vasco Aragao M.
        • van der Linden V.
        • Petribu N.C.
        • Valenca M.M.
        • Parizel P.M.
        • de Mello R.J.V.
        Congenital Zika syndrome: the main cause of death and correspondence between brain CT and postmortem histological section findings from the same individuals.
        Top Magn Reson Imaging. 2019; 28: 29-33
        • Wittenberg G.F.
        Neural plasticity and treatment across the lifespan for motor deficits in cerebral palsy.
        Dev Med Child Neurol. 2009; 51: 130-133
        • Goldstein M.
        The treatment of cerebral palsy: what we know, what we don't know.
        J Pediatr. 2004; 145: S42-S46
        • Gordon A.M.
        • Schneider J.A.
        • Chinnan A.
        • Charles J.R.
        Efficacy of a hand-arm bimanual intensive therapy (HABIT) in children with hemiplegic cerebral palsy: a randomized control trial.
        Dev Med Child Neurol. 2007; 49: 830-838
        • Nudo R.J.
        Adaptive plasticity in motor cortex: implications for rehabilitation after brain injury.
        J Rehabil Med. 2003; 41: 7-10
        • Centers for Disease Control and Prevention
        Testing for Zika virus.
        (Available at:) (Accessed November 16, 2020)
        • Pedrozo L.
        • Thomas J.
        • de Oliveira L.
        • Paiva B.
        Protocolo do Pediasuit.
        in: Assis R.D. Condutas práticas em fisioterapia neurológica. Manole, Barueri, Brazil2012
        • Scheeren E.M.
        • Mascarenhas L.P.G.
        • Chiarello C.R.
        • Costin A.C.M.S.
        • Oliveira L.
        • Neves E.B.
        Description of the Pediasuit Protocol.
        Fisioter Mov. 2012; 25: 473-480
        • Franca T.L.B.
        • Medeiros W.R.
        • Souza N.L.
        • et al.
        Growth and development of children with microcephaly associated with congenital Zika virus syndrome in Brazil.
        Int J Environ Res Public Health. 2018; 15: 1990
        • Dos Santos S.F.M.
        • Soares F.V.M.
        • de Abranches A.D.
        • da Costa A.C.C.
        • Moreira M.E.L.
        • de Matos Fonseca V.
        Infants with microcephaly due to Zika virus exposure: nutritional status and food practices.
        Nutr J. 2019; 18: 4
        • Shin J.W.
        • Song G.B.
        • Hwangbo G.
        Effects of conventional neurological treatment and a virtual reality training program on eye-hand coordination in children with cerebral palsy.
        J Phys Ther Sci. 2015; 27: 2151-2154
        • Lucas B.R.
        • Elliott E.J.
        • Coggan S.
        • et al.
        Interventions to improve gross motor performance in children with neurodevelopmental disorders: a meta-analysis.
        BMC Pediatr. 2016; 16: 193
        • Dewar R.
        • Love S.
        • Johnston L.M.
        Exercise interventions improve postural control in children with cerebral palsy: a systematic review.
        Dev Med Child Neurol. 2015; 57: 504-520
        • Palisano R.
        • Rosenbaum P.
        • Bartlett D.
        • Livingston M.
        GMFCS - E & R gross motor function classification system: expanded and revised.
        (Available at:) (Accessed November 16, 2020)
        • Russell D.J.
        • Rosenbaum P.L.
        • Cadman D.T.
        • Gowland C.
        • Hardy S.
        • Jarvis S.
        The gross motor function measure: a means to evaluate the effects of physical therapy.
        Dev Med Child Neurol. 1989; 31: 341-352
        • Begnoche D.M.
        • Pitetti K.H.
        Effects of traditional treatment and partial body weight treadmill training on the motor skills of children with spastic cerebral palsy. A pilot study.
        Pediatr Phys Ther. 2007; 19: 11-19
        • Curtis D.J.
        • Butler P.
        • Saavedra S.
        • et al.
        The central role of trunk control in the gross motor function of children with cerebral palsy: a retrospective cross-sectional study.
        Dev Med Child Neurol. 2015; 57: 351-357
        • Park E.Y.
        Effect of physical therapy frequency on gross motor function in children with cerebral palsy.
        J Phys Ther Sci. 2016; 28: 1888-1891
        • Willingham D.B.
        A neuropsychological theory of motor skill learning.
        Psychol Rev. 1998; 105: 558-584
        • Ismail F.Y.
        • Fatemi A.
        • Johnston M.V.
        Cerebral plasticity: windows of opportunity in the developing brain.
        Eur J Paediatr Neurol. 2017; 21: 23-48
        • DeLuca S.C.
        • Wallace D.A.
        • Trucks M.R.
        • Mukherjee K.
        A clinical series using intensive neurorehabilitation to promote functional motor and cognitive skills in three girls with CASK mutation.
        BMC Res Notes. 2017; 10: 743
        • Barrett A.M.
        • Oh-Park M.
        • Chen P.
        • Ifejika N.L.
        Neurorehabilitation: five new things.
        Neurol Clin Pract. 2013; 3: 484-492
        • Botelho A.C.G.
        • Neri L.M.
        • da Silva M.Q.F.
        • et al.
        Presumed congenital infection by Zika virus: findings on psychomotor development - a case report.
        Rev Bras Saude Mater Infant. 2016; 16: 39-44
        • Pessoa A.
        • van der Linden V.
        • Yeargin-Allsopp M.
        • et al.
        Motor abnormalities and epilepsy in infants and children with evidence of congenital Zika virus infection.
        Pediatrics. 2018; 141: S167-S179
        • Melo A.
        • Gama G.L.
        • Da Silva Junior R.A.
        • et al.
        Motor function in children with congenital Zika syndrome.
        Dev Med Child Neurol. 2020; 62: 221-226
        • Souza W.V.
        • Albuquerque M.
        • Vazquez E.
        • et al.
        Microcephaly epidemic related to the Zika virus and living conditions in Recife, Northeast Brazil.
        BMC Public Health. 2018; 18: 130