Influência do treino de marcha com órtese robótica em indivíduos com ataxia pós acidente vascular cerebral
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Data
2018-02-15
Autores
Santos, Marcia Belas dos [UNIFESP]
Orientadores
Arida, Ricardo Mario [UNIFESP]
Tipo
Tese de doutorado
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O treino de marcha com assistência robótica (TMAR) tem sido descrito como uma opção valiosa no tratamento de reabilitação de indivíduos acometidos por acidente vascular cerebral (AVC). Poucos estudos têm verificado os efeitos da reabilitação em indivíduos com desordens do movimento, especificamente ataxia e nenhum deles associou o TMAR em pacientes crônicos com sequela de AVC Objetivos: Avaliar a influência do TMAR associado a fisioterapia no equilíbrio, coordenação motora e independência funcional nas atividades de vida diária de indivíduos com ataxia pós AVC. Métodos: Total de quinze indivíduos foram alocados em dois grupos, treino de marcha realizado no solo (TMRS) e TMAR. Ambos os grupos receberam três sessões de fisioterapia por semana associando-se exercícios prescritos para casa. O grupo TMRS foi submetido a treino de marcha realizado no solo, já o grupo TMAR o treino de marcha foi assistido com equipamento robótico. O tempo estimado de cada sessão foi de 60 minutos, por um período de cinco meses. As seguintes escalas funcionais para avaliação foram aplicadas: escala de equilíbrio de Berg, teste Timed Up and Go (TUG), medida de independência funcional (MIF), e a escala para avaliação e graduação de ataxia SARA, respectivamente em dois momentos antes e após completarem o protocolo de treino proposto. Resultados: Após completarem o protocolo de treino estabelecido, ambos os grupos evidenciaram melhora estatisticamente significante (p< 0,05) no equilíbrio, execução nas atividades de vida diária e sequelas gerais decorrentes da ataxia. Não foram encontrados diferença estatística (p < 0,05) quando realizado comparação entre os grupos, indicando que ambos os protocolos foram benéficos na reabilitação de indivíduos acometidos por AVC com sequela de ataxia. Conclusão: Indivíduos acometidos por AVC com sequela de ataxia em fase crônica de reabilitação apresentaram melhora significativa no equilíbrio, independência funcional geral nas atividades de vida diária quando submetidos a treino de marcha com ou sem assistência robótica associado a orientações para domicílio. No entanto, quando comparado ambos os grupos não foi encontrado diferença estatisticamente significante.
Background: Robot-assisted gait training (RAGT) has been described as a beneficial option for rehabilitation treatment after stroke. Few studies have reported the effects of rehabilitation on ataxia disorders, and none of them have assessed the effect of RAGT on chronic stroke patients with ataxia. Objectives: To assess the influence of RAGT on balance, coordination, and functional independence in activities of daily living of chronic stroke survivors with ataxia after at least one year of injury. Methods: Fifteen patients were allocated to either therapist-assisted gait training (TAGT) or RAGT in this prospective, randomized study. Both groups were submitted to 3 weekly sessions of physiotherapy with an estimated duration of 60 minutes each in addition to prescribed home exercises during 5 months. Two sessions were conventional physiotherapy and 1 session was either conventional gait training or robotic gait training. The following outcome measures were evaluated prior to and after the completion of the 5-month protocol treatment: the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, the Functional Independence Measure (FIM), and the Scale for the Assessment and Rating of Ataxia (SARA). Results: After protocol treatment, both groups showed statistically significant improvement (p< 0.05) in balance, functional independence in daily living activities, and general ataxia sequela symptoms. There were no statistically significant differences (p < 0.05) for between-group comparisons at both baseline and after completion of the protocol. Conclusions: Chronic stroke patients with ataxia sequela had significant improvements in balance and independence in activities of daily living after RAGT along with conventional therapy and home exercises. However, when compared both groups there were no statistically significant differences.
Background: Robot-assisted gait training (RAGT) has been described as a beneficial option for rehabilitation treatment after stroke. Few studies have reported the effects of rehabilitation on ataxia disorders, and none of them have assessed the effect of RAGT on chronic stroke patients with ataxia. Objectives: To assess the influence of RAGT on balance, coordination, and functional independence in activities of daily living of chronic stroke survivors with ataxia after at least one year of injury. Methods: Fifteen patients were allocated to either therapist-assisted gait training (TAGT) or RAGT in this prospective, randomized study. Both groups were submitted to 3 weekly sessions of physiotherapy with an estimated duration of 60 minutes each in addition to prescribed home exercises during 5 months. Two sessions were conventional physiotherapy and 1 session was either conventional gait training or robotic gait training. The following outcome measures were evaluated prior to and after the completion of the 5-month protocol treatment: the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, the Functional Independence Measure (FIM), and the Scale for the Assessment and Rating of Ataxia (SARA). Results: After protocol treatment, both groups showed statistically significant improvement (p< 0.05) in balance, functional independence in daily living activities, and general ataxia sequela symptoms. There were no statistically significant differences (p < 0.05) for between-group comparisons at both baseline and after completion of the protocol. Conclusions: Chronic stroke patients with ataxia sequela had significant improvements in balance and independence in activities of daily living after RAGT along with conventional therapy and home exercises. However, when compared both groups there were no statistically significant differences.
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SANTOS, Marcia Belas dos. Influência do treino de marcha com órtese robótica em indivíduos com ataxia pós acidente vascular cerebral. 2018. Tese (Doutorado em Neurologia/Neurociências) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2018.