Crioterapia e cinesioterapia no membro superior espástico no acidente vascular cerebral

Correlação entre espasticidade do membro superior e movimentação da mão no pós-AVC

RESUMO A hemiparesia e a espasticidade são consequências comuns em pacientes que sofreram um acidente vascular cerebral (AVC) e delas decorre a dificuldade do paciente de movimentar o hemicorpo acometido. O objetivo deste estudo foi, assim, verificar a relação da espasticidade no membro superior (MS) com a capacidade de movimentação da mão desses pacientes, a partir de um estudo transversal de delineamento ex-post facto correlacional. Foram avaliados pacientes que realizavam acompanhamento no Ambulatório Neurovascular do Hospital de Clínicas de Porto Alegre (HCPA). Foi preenchida uma ficha de avaliação com dados da amostra e realizada a avaliação da espasticidade do MS, por meio da escala de Ashworth modificada (MAS), e da movimentação ativa da mão, por meio da escala de movimentação da mão (EMM). Para a correlação das variáveis, foi usado o coeficiente de correlação tau de Kendall, adotando-se um nível de significação de 5% (p≤0,05). Foram avaliados 47 sujeitos de ambos os sexos com média de idade de 64,5 (±13) anos e média de tempo de AVC de 2,7 (±1,8) meses. A moda da EMM foi de 6 pontos e 74,4% dos pacientes não eram espásticos. O movimento da mão apresentou correlação significativa negativa com as musculaturas espásticas avaliadas. Houve uma correlação negativa moderada com as musculaturas peitoral (r=−0,383; p=0,007), os flexores de cotovelo (r=−0,339; p=0,016) e pronadores (r=−0,460; p=0,001), e correlação negativa alta com os flexores de punho (r=−0,588; p<0,001) e os flexores de dedos (r=−0,692; p<0,001). Concluiu-se que quanto maior o grau de espasticidade do membro superior, menor a capacidade de movimentação da mão dos pacientes.

Correlation between upper limb spasticity and hand movement after stroke

ABSTRACT Hemiparesis and spasticity are common consequences in stroke patients, hampering the movement in the affected side. Our study aimed to correlate upper limb spasticity and the ability to move the hand in these patients. This is a quantitative cross-sectional study with an ex post facto correlational design. We evaluated patients undergoing follow-up at the Neurovascular Outpatient Clinic at the Hospital de Clínicas de Porto Alegre. An evaluation form was filled out with sample data and the upper limb spasticity was evaluated using the Modified Ashworth Scale and the active hand movement using the Hand Movement Scale. Correlation of variables were verified using Kendall’s rank correlation coefficient. A significance level of 5% (p≤0.05) was adopted. In total, we evaluated 47 subjects of all genders, with a mean age of 64.5 (±13) years and a mean stroke time of 2.7 (±1.8) months. The Hand movement Scale mode was 6 points, and 74.4% of patients were not spastic. Hand movement showed a significant negative correlation with the spastic muscles evaluated. There was a moderate negative correlation with the pectoral muscles (r=−0.383; p=0.007), elbow flexors (r=−0.339; p=0.016) and pronators (r=−0.460; p=0.001) and high negative correlation with wrist flexors (r=−0.588; p<0.001) and finger flexors (r=−0.692; p<.001). The greater the degree of spasticity of the upper limb, the smaller the hand movement capacity in stroke patients.

Immediate effects of low-intensity laser (808 nm) on fatigue and strength of spastic muscle

The cerebrovascular accident (CVA), high-impact disease II, affects the basic functions of the limbs, leading to changes of sensory, language, and motor functions. The search for resources that minimize the damage caused by this disease grows every day. The clinical use of low-intensity laser therapy (LILT) has provided major breakthroughs in the treatment of muscular disorders and prevention of muscle fatigue. Thus, the objective of the present study is to analyze the answers and immediate adaptations of the rectus femoris and vastus medialis of spastic hemiparetic patients, facing the increase in peak torque and triggering muscle fatigue, after application of LILT. Double-blind clinical trials were conducted with 15 volunteers post-CVA with spasticity, of both genders, between 40 and 80 years old. To this end, the volunteers went through three consecutive stages of rating (control, placebo, and laser). All performed tests of isometric contraction on the patient's hemiparetic side. Significant differences were observed with regard to the increase in muscle performance (p = 0.0043) and the reduction in blood lactate concentration (p < 0.0001) of the post-LILT muscles. The LILT (diode laser, l100 mW 808 nm, 4.77 J/cm(2)/point, 40 s/AP) can be employed during and after spastic muscle-strengthening exercises, contributing to the improvement of motor function of the patient. After application of LILT, we found increased torque as well as decreased in lactate level in patients with spasticity.

Use of functional bandages in patients with stroke

Introduction Functional bandages have been used in physiotherapeutic practice with the purpose of minimizing disabilities and favoring functional improvement. However, there is still a shortage of research regarding the use of these devices in patients with neurological sequelae, especially those resulting from stroke. Objective To report the motor evolution of patients living with sequelae of stroke, who have been submitted to the use of functional bandages associated with conventional physical therapy. Materials and methods We assessed the active range of motion, strength and degree of spasticity in the flexor and extensor muscles of the wrist and elbow joints, and functionality of the upper limb during the performance of daily activities at the first and the twentieth session of conventional physical therapy associated with the use of functional bandages. Results There was an increase in range of motion and muscle strength of patients, and reduction in spasticity of the wrist and elbow flexor muscles. Conversely, the functionality scores remained similar before and after treatment. Conclusion The subjects of this study showed a good evolution in the aspects studied. Thus, the use of functional bandages associated with conventional physical therapy seems to contribute to the rehabilitation of patients with stroke sequelae. Further research needs to be conducted in order to increase the scientific evidence regarding the effectiveness of functional bandages in the treatment of patients with stroke sequelae.