Efeito imediato do uso de órtese de punho na coordenação muscular e na cinemática da extremidade superior de indivíduos sem disfunção e com síndrome do túnel do carpo
Data
2023-10-30
Autores
Figueiredo, Danielle Soares 
Orientadores
Carvalho, Raquel de Paula
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Restringir a articulação do punho pode alterar a coordenação muscular e a cinemática proximal da extremidade superior de indivíduos sem disfunções. É fundamental avaliar esses efeitos em populações com disfunções que usam contenção articular no punho, como indivíduos com síndrome do túnel do carpo (STC) que comumente relatam dor no ombro. Assim, o objetivo geral dessa tese foi verificar os efeitos do uso da órtese de punho na coordenação muscular e na cinemática de indivíduos sem disfunção e com STC. Para isso, essa tese foi dividida em três estudos. O Estudo 1 foi uma Revisão Sistemática para primeiramente examinar a efetividade da órtese de punho na redução da dor de indivíduos com STC. A estratégia de busca foi realizada em sete importantes bases de dados. Após o processo de triagem e elegibilidade, três ensaios clínicos aleatorizados, dois ensaios não aleatorizados e um observacional foram incluídos e avaliados sobre o risco de viés pela ferramenta da Colaboração Cochrane. A amostra final variou entre 24 e 91 indivíduos com média de idade entre 42,4 e 58,2 anos. Os estudos utilizaram escalas de autorrelato da dor e mostraram que o uso isolado de órtese reduz a intensidade da dor em indivíduos com STC. O Estudo 2 foi uma Revisão Sistemática para identificar os efeitos da contenção articular de punho na atividade eletromiográfica e na cinemática da extremidade superior de adultos sem disfunções. O método foi semelhante ao Estudo 1, exceto que a avaliação metodológica dos estudos foi realizada pelo Strengthening the Reporting of Observational Studies in Epidemiology checklist e a Newcastle - Ottawa Quality Assessment Scale. Após o processo de triagem e elegibilidade, 13 estudos observacionais foram incluídos. A amostra compreendeu 254 indivíduos entre 18 e 50 anos de idade avaliados em tarefas com e sem diferentes tipos de contenção articular no punho, o que alterou a atividade eletromiográfica de músculos da extremidade superior e a cinemática linear e ângulos articulares de adultos sem disfunções. Esses resultados auxiliaram no delineamento do Estudo 3, que teve o objetivo de avaliar os efeitos imediatos da órtese de punho na coordenação muscular e na cinemática da extremidade superior de indivíduos sem disfunção e de indivíduos com STC. Cinco mulheres entre 22 e 44 anos foram alocadas no Grupo Controle, e três mulheres entre 53 e 64 anos foram alocadas no Grupo STC. O experimento foi realizado em uma única sessão, que iniciou com anamnese, aplicação de questionários, avaliação de pinças e intensidade de dor. Após, a cinemática e os sinais eletromiográficos de músculos da extremidade superior dominante direita foram amostrados durante tarefas de elevação no plano escapular e de alcance, em três procedimentos: (SO1) sem órtese, (CO) com órtese, e (SO2) imediatamente após retirar a órtese. Após, a intensidade de dor foi avaliada novamente. Os testes Kruskal-Wallis, Friedman e Anova foram utilizados com nível de significância adotado ≤0,05. Os resultados da tarefa de elevação mostraram que o Grupo STC apresentou menor duração, distância percorrida e pico de deslocamento comparado ao Controle. Ambos os grupos apresentaram maior número de sinergias musculares encontradas e maior informação mútua entre os sinais eletromiográficos na sessão SO2. Na avaliação da tarefa de alcance, o Grupo STC apresentou menor distância percorrida na sessão SO1 e SO2 e menor velocidade média na sessão SO1. As alterações encontradas na sessão SO2 podem sugerir que houve um aumento compensatório na coordenação muscular proximal como um mecanismo de estabilização dessas articulações como resposta imediata à restrição articular imposta pela órtese. Conclui-se que a órtese de punho pode alterar de maneira imediata a coordenação muscular e cinemática da extremidade superior de indivíduos com e sem STC. Os resultados devem ser interpretados com cautela visto que são preliminares.
Restricting the wrist joint can alter muscle coordination and proximal kinematics of the upper extremity in individuals without dysfunction. It is essential to evaluate these effects in populations with dysfunctions that use wrist joint restraint, such as individuals with carpal tunnel syndrome (CTS) who commonly report shoulder pain. Thus, the general objective of this thesis was to verify the effects of using wrist orthoses on muscle coordination and kinematics in individuals without dysfunction and with CTS. To achieve this, this thesis was divided into three studies. Study 1 was a Systematic Review to first examine the effectiveness of wrist orthoses in reducing pain in individuals with CTS. The search strategy was carried out in seven important databases. After the screening and eligibility process, three randomized clinical trials, two non-randomized trials and one observational study were included and assessed for risk of bias using the Cochrane Collaboration tool. The final sample ranged between 24 and 91 individuals with a mean age between 42.4 and 58.2 years. The studies used self-report pain scales and showed that the isolated use of an orthosis reduces the intensity of pain in individuals with CTS. Study 2 was a Systematic Review to identify the effects of wrist joint restraint on electromyographic activity and upper extremity kinematics in adults without dysfunction. The method was similar to Study 1, except that the methodological evaluation of the studies was carried out using the Strengthening the Reporting of Observational Studies in Epidemiology checklist and the Newcastle - Ottawa Quality Assessment Scale. After the screening and eligibility process, 13 observational studies were included. The sample comprised 254 individuals between 18 and 50 years of age evaluated in tasks with and without different types of joint restraint in the wrist, which altered the electromyographic activity of upper extremity muscles and the linear kinematics and joint angles of adults without dysfunctions. These results helped in the design of Study 3, which aimed to evaluate the immediate effects of the wrist orthosis on the muscular coordination and kinematics of the upper extremity of individuals without dysfunction and individuals with CTS. Five women between 22 and 44 years old were allocated to the Control Group, and three women between 53 and 64 years old were allocated to the STC Group. The experiment was carried out in a single session, which began with anamnesis, questionnaires, assessment of pinch strength and pain intensity. Afterwards, the kinematics and electromyographic signals of muscles of the dominant right upper extremity were sampled during arm elevation in the scapular plane, and reaching task, in three procedures: (SO1) without orthosis, (CO) with orthosis, and (SO2) immediately after remove the orthosis. Afterwards, pain intensity was assessed again. The Kruskal-Wallis, Friedman and Anova tests were used with a significance level of ≤0.05. The results of the arm elevation showed that the STC Group had a shorter duration, distance covered and peak displacement compared to the Control. Both groups showed a greater number of synergies found and greater mutual information between the electromyographic signals in the SO2 session. In the evaluation of the reaching task, the STC Group presented a shorter distance covered in the SO1 and SO2 sessions and a lower average speed in the SO1 session. The changes found in the SO2 session may suggest that there was a compensatory increase in proximal muscular coordination as a mechanism for stabilizing these joints as an immediate response to the joint restriction imposed by the orthosis. It is concluded that the wrist orthosis can immediately change the muscular and kinematic coordination of the upper extremity in individuals with and without CTS. The results should be interpreted with caution as they are preliminary.
Restricting the wrist joint can alter muscle coordination and proximal kinematics of the upper extremity in individuals without dysfunction. It is essential to evaluate these effects in populations with dysfunctions that use wrist joint restraint, such as individuals with carpal tunnel syndrome (CTS) who commonly report shoulder pain. Thus, the general objective of this thesis was to verify the effects of using wrist orthoses on muscle coordination and kinematics in individuals without dysfunction and with CTS. To achieve this, this thesis was divided into three studies. Study 1 was a Systematic Review to first examine the effectiveness of wrist orthoses in reducing pain in individuals with CTS. The search strategy was carried out in seven important databases. After the screening and eligibility process, three randomized clinical trials, two non-randomized trials and one observational study were included and assessed for risk of bias using the Cochrane Collaboration tool. The final sample ranged between 24 and 91 individuals with a mean age between 42.4 and 58.2 years. The studies used self-report pain scales and showed that the isolated use of an orthosis reduces the intensity of pain in individuals with CTS. Study 2 was a Systematic Review to identify the effects of wrist joint restraint on electromyographic activity and upper extremity kinematics in adults without dysfunction. The method was similar to Study 1, except that the methodological evaluation of the studies was carried out using the Strengthening the Reporting of Observational Studies in Epidemiology checklist and the Newcastle - Ottawa Quality Assessment Scale. After the screening and eligibility process, 13 observational studies were included. The sample comprised 254 individuals between 18 and 50 years of age evaluated in tasks with and without different types of joint restraint in the wrist, which altered the electromyographic activity of upper extremity muscles and the linear kinematics and joint angles of adults without dysfunctions. These results helped in the design of Study 3, which aimed to evaluate the immediate effects of the wrist orthosis on the muscular coordination and kinematics of the upper extremity of individuals without dysfunction and individuals with CTS. Five women between 22 and 44 years old were allocated to the Control Group, and three women between 53 and 64 years old were allocated to the STC Group. The experiment was carried out in a single session, which began with anamnesis, questionnaires, assessment of pinch strength and pain intensity. Afterwards, the kinematics and electromyographic signals of muscles of the dominant right upper extremity were sampled during arm elevation in the scapular plane, and reaching task, in three procedures: (SO1) without orthosis, (CO) with orthosis, and (SO2) immediately after remove the orthosis. Afterwards, pain intensity was assessed again. The Kruskal-Wallis, Friedman and Anova tests were used with a significance level of ≤0.05. The results of the arm elevation showed that the STC Group had a shorter duration, distance covered and peak displacement compared to the Control. Both groups showed a greater number of synergies found and greater mutual information between the electromyographic signals in the SO2 session. In the evaluation of the reaching task, the STC Group presented a shorter distance covered in the SO1 and SO2 sessions and a lower average speed in the SO1 session. The changes found in the SO2 session may suggest that there was a compensatory increase in proximal muscular coordination as a mechanism for stabilizing these joints as an immediate response to the joint restriction imposed by the orthosis. It is concluded that the wrist orthosis can immediately change the muscular and kinematic coordination of the upper extremity in individuals with and without CTS. The results should be interpreted with caution as they are preliminary.
Descrição
Citação
FIGUEIREDO, Danielle Soares. Efeito imediato do uso de órtese de punho na coordenação muscular e na cinemática da extremidade superior de indivíduos sem disfunção e com síndrome do túnel do carpo. 2023. 181 f. Tese (Doutorado Interdisciplinar em Ciências da Saúde ) - Universidade Federal de São Paulo, Instituto de Saúde e Sociedade, Santos, 2023.