Eficácia da terapia de restrição e indução do movimento de membro inferior na marcha de indivíduos após acidente vascular encefálico

• Autor(a) principal: Lopes, Paula Thais do Nascimento
• Data de Publicação: 2019
• Outros Autores: Oliveira, Weslla dos Santos
• Tipo de documento: Trabalho de conclusão de curso
• Idioma: por
• Título da fonte: Repositório Institucional da UFS
• Texto Completo: http://ri.ufs.br/jspui/handle/riufs/13490
• topic: Acidente vascular cerebral; Marcha humana; Fisioterapia; Acidente Vascular Encefálico; Terapia de Restrição e Indução do Movimento; Stroke; Gait; Physiotherapy; Constraint and Induced Therapy

Introduction: Stroke is considered a public health problem because of its significant disability. Stroke can cause several functional disorders among them is gait impairment. In the field of Neurologic Physical Therapy, many types of resources and therapeutic modalities are used as a form of treatment for individuals following Stroke, among them the functional training with constraint and movement induction has been proved efficient. However, there are still few clinical trials on the effectiveness of Constraint and Induction of Movement Therapy (CIT) applied to the lower limbs (LL). Objective: To investigate the effectiveness of Constraint and Induction Therapy of Lower Limbs – CIT - LL on the gait after-stroke. Methods: This study is the type to test efficacy, case series with a quantitative. The experimental protocol was performed in 10 visits, with a total duration of 1 month and 1 week, 2 times a week, for approximately 50 minutes. Multiple-assessments distributed in three fases A1-B-A2, where A1 consisted of two assessments prior to initiation of treatment, B two measures during treatment and A2 consisted of two further post-treatment evaluations. The instruments were used as primary outcomes are: for the effect in the community gait - Dynamic Gait Index (DGI), for the effect on balance and mobility - Fullerton's Advanced Balance Scale and the Time Up and Go (T.U.G) test. For weight distribution on the lower limb - the maximum pressure of the foot surfaces with static Baropodometry. As a secondary outcome, the 6- minute Walk Test (6MWT) was used to analyze the walking distance. Three statistical methods were used: 1) To calculate the effect of weight distribution, the differences between the pressures of plantar surfaces on the affected and unaffected side, before and after the treatment, were calculated with the baropodometer. The differences of the means before and after were compared using the student T test, with two tails and significance level p <0.05. 2) The visual statistical method was performed with the two standard deviations and mean from the baseline evaluations (before treatment), where each point that leaves the band has a significance of p <0.05. 3) The calculation of the effect size of the therapy was also performed, by using the difference between the means over the standard deviation from the two baseline evaluations. Results: Three volunteers with stroke sequelae participated in the study, mean age of 50.6 ± 6.6 years. After application of the CIT-LL together w ith tasks oriented training the results regarding the analysis of the plantar surface were positive for P2 and P3, with T = 5.2 and p = 0.006, T = 2.82 and p = 0.047, respectively. P1 had no difference in the distribution of the plantar surface after treatment. As for the analysis of the scores obtained in the DGI, FAB and TUG evaluations, there was improvement in locomotion, as well as balance and mobility in all three participants, with scores coming out of the 2SD band during and after treatment (p < 0,05). Effects sizes after therapy were large and huge (> 0.80 and 1.30). In the TC6 instrument, only one patient (P3) did not change after treatment, reaching values lower than baseline values after one month of treatment. Conclusion: Our results suggest that the intervention with TRIM-MMII allows positive effects in independent locomotion increasing the capacity to perform the functional tasks required during walking.