Efeitos da terapia por contensão induzida para membros inferiores sobre a funcionalidade da marcha e equilíbrio em pacientes hemiparéticos crônicos pós acidente vascular cerebral: ensaio clínico controlado, aleatorizado e cego
Arquivos
Data
2021-10-08
Autores
Menezes de Oliveira, Elaine [UNIFESP]
Orientadores
Arida, Ricardo Mario [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A Terapia por Contensão Induzida (TCI) é um protocolo de prática intensiva e aparece atualemente como uma das melhores opções na reabilitação do membro superior, entretanto poucas são as pesquisas com esta abordagem para membros inferiores e seus efeitos na marcha e equilíbrio.
Objetivo: Avaliar os efeitos da Terapia por Contensão Induzida sobre a funcionalidade da marcha e equilíbrio em pacientes crônicos pós Acidente Vascular Cerebral (AVC).
Metodologia: Trata-se de um estudo controlado, aleatorizado e cego. Trinta e nove pacientes com diagnóstico de AVC, na fase crônica da reabilitação (>6 meses), com déficit de marcha (sem marcha comunitária), capaz de andar pelo menos 10 metros com ou sem dispositivo auxiliar de marcha ou suporte de 1 pessoa, foram aleatoriamente alocados em 2 grupos: TCI para membros inferiores (TCI-MMII) e Grupo Controle (Terapia Convencional Intensiva). Os critérios de exclusão adotados foram: déficit de linguagem que impossibilitasse a compreensão e/ou adequada resposta às escalas de avaliação e exercícios propostos e/ou intercorrência clínica entre a triagem e o início do protocolo. Os pacientes foram avaliados em 3 momentos: Pré-tratamento, Pós-tratamento e Follow-up de 6 meses. Os instrumentos escolhidos para este ensaio clínico foram: Teste de Caminhada de 6 minutos (TC 6min), Teste de Caminhada de 10 metros (TC 10m), Timed Up And Go (TUG), Análise 3-D da marcha, Mini-Balance Evaluation Systems Test (Mini-BESTest) e, Lower Extremity-Motor Activity Log (LE-MAL). Os participantes do grupo TCI foram submetidos à 2,5h/dia de intervenção por 15 dias consecutivos, que incluiu: 1) Prática intensiva supervisionada, 2) Uso de shaping como estratégia de treinamento motor e 3) aplicação do pacote de transferência (mais 0,5h/dia). O Grupo Controle recebeu Terapia Convencional Intensiva também por 2,5h/dia de intervenção por 15 dias consecutivos. Para análise estatística adotou-se a análise por intenção de tratar. A ANOVA para medidas repetidas foi utilizada para comparar diferenças e definir mudanças clinicamente relevantes entre os grupos.
Resultados: Ambos os grupos apresentaram melhora nos desfechos avaliados após os protocolos, esses ganhos foram estatisticamente significantes nos subitens de desempenho, confiança e assistência da LE-MAL e no equilíbrio medido pelo Mini-BESTest, entretanto somente o grupo TCI mostrou retenção desses resultados no follow-up (FUP) de 6 meses. Não houve diferença nos desfechos de capacidade e parâmetros espaço-temporais da marcha intra ou intergrupos.
Conclusão: A TCI-MMII é capaz de gerar resultados positivos sobre os desfechos de equilíbrio e melhora da percepção de desempenho e confiança, além de redução da necessidade de assistência para essas mesmas tarefas mantidos à médio prazo.
Background: Constraint Induced Movement Therapy (CIT) is an intensive approach and it appears to be one of the best options for better outcomes in upper limb rehabilitation, but we still have little data about Lower Extremities - Constraint Induced Movement Therapy (LE-CIT) and its effects on gait and balance. Objective: To evaluate the effects of an LE-CIT protocol on gait functionality and balance in chronic hemiparetic patients following a stroke. Methods: The study adopts a randomized, controlled, single-blinded study design. Thirty-nine patients who suffered a stroke in the chronic phase of recovery (>6 months), with gait disability (no community gait), able to walk at least 10 meters with or without the advice or support of 1 person, were randomly allocated to 2 groups: LECIT Group or the Control Group (Intensive Conventional Therapy). Exclusion criteria: speech deficits that render them unable to understand and/or answer properly to evaluation scales and selected exercises for the protocol and/or if they have suffered any clinical event between the screening and the beginning of the protocol. Outcome were assessed at baseline, immediately after the intervention, and after 6 months. The outcome measures chosen for this trial were 6-minute walk test (6minWT), 10-meter walk test (10mWT), Timed Up and Go (TUG), 3-D gait analysis (3DGA), Mini-Balance Evaluation Systems Test (Mini-BESTest) and Lower Extremity Motor Activity Log (LEMAL). The participants in both groups were submitted to 15 followed days of daily exercise. The participants in the LE-CIT Group were submitted to this protocol 2.5 hour/day for 15 followed days. It included: 1) intensive supervised training, 2) use of shaping as strategy for motor training, and 3) application of a transfer package (plus 30 minutes). The Control Group received conventional physiotherapy for 2.5 hours/day over 15 followed days (the same period as the CIT intervention). For statistical analysis we adopted intention to treat analysis. The ANOVA for repeated measures analyses were made to compare differences and define clinically relevant changes between groups. Results: Both groups showed improvement in all the outcomes measured after the protocols. They were statistically significant for performance, confidence and assistance sub-items of LE-MAL and for balance, measured through Mini-BESTest. However only the LE-CIT group showed retention of these results in the follow-up (FUP) evaluation. There was no significant difference for the outcomes related to gait capacity and spatiotemporal parameters intra or inter-group. Conclusion: LE-CIT protocol is able to generate positive outcomes on balance, performance and confidence perception, besides to reducing the need of assistance for these same tasks and maintain them after 6 months.
Background: Constraint Induced Movement Therapy (CIT) is an intensive approach and it appears to be one of the best options for better outcomes in upper limb rehabilitation, but we still have little data about Lower Extremities - Constraint Induced Movement Therapy (LE-CIT) and its effects on gait and balance. Objective: To evaluate the effects of an LE-CIT protocol on gait functionality and balance in chronic hemiparetic patients following a stroke. Methods: The study adopts a randomized, controlled, single-blinded study design. Thirty-nine patients who suffered a stroke in the chronic phase of recovery (>6 months), with gait disability (no community gait), able to walk at least 10 meters with or without the advice or support of 1 person, were randomly allocated to 2 groups: LECIT Group or the Control Group (Intensive Conventional Therapy). Exclusion criteria: speech deficits that render them unable to understand and/or answer properly to evaluation scales and selected exercises for the protocol and/or if they have suffered any clinical event between the screening and the beginning of the protocol. Outcome were assessed at baseline, immediately after the intervention, and after 6 months. The outcome measures chosen for this trial were 6-minute walk test (6minWT), 10-meter walk test (10mWT), Timed Up and Go (TUG), 3-D gait analysis (3DGA), Mini-Balance Evaluation Systems Test (Mini-BESTest) and Lower Extremity Motor Activity Log (LEMAL). The participants in both groups were submitted to 15 followed days of daily exercise. The participants in the LE-CIT Group were submitted to this protocol 2.5 hour/day for 15 followed days. It included: 1) intensive supervised training, 2) use of shaping as strategy for motor training, and 3) application of a transfer package (plus 30 minutes). The Control Group received conventional physiotherapy for 2.5 hours/day over 15 followed days (the same period as the CIT intervention). For statistical analysis we adopted intention to treat analysis. The ANOVA for repeated measures analyses were made to compare differences and define clinically relevant changes between groups. Results: Both groups showed improvement in all the outcomes measured after the protocols. They were statistically significant for performance, confidence and assistance sub-items of LE-MAL and for balance, measured through Mini-BESTest. However only the LE-CIT group showed retention of these results in the follow-up (FUP) evaluation. There was no significant difference for the outcomes related to gait capacity and spatiotemporal parameters intra or inter-group. Conclusion: LE-CIT protocol is able to generate positive outcomes on balance, performance and confidence perception, besides to reducing the need of assistance for these same tasks and maintain them after 6 months.
Descrição
Citação
OLIVEIRA, Elaine Menezes de. São Paulo, 2021. 126 f. Dissertação (Mestrado em Neurologia/Neurociências) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2021.