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Previous issue date: 2016-05-10 / Introdu??o: A marcha ap?s Acidente Vascular Cerebral (AVC) caracteriza-se por expressiva assimetria entre os membros inferiores, com o uso preponderante do membro inferior n?o-par?tico (MINP) em detrimento do uso do membro inferior par?tico. Nesse sentido, tem sido sugerido que adi??o de carga ao MINP como forma de restri??o ao movimento deste membro possa favorecer o uso do membro par?tico, reduzindo a assimetria intermembros. Contudo, h? poucos estudos realizados at? o momento, os quais t?m investigado apenas os efeitos imediatos dessa abordagem. Objetivos: 1) Investigar se h? influ?ncia da adi??o de carga ao MINP durante o treinamento em esteira sobre os par?metros cardiovasculares e sobre a performance da marcha de indiv?duos com AVC; 2) Analisar os efeitos do treinamento em esteira com e sem adi??o de carga ao MINP sobre os par?metros cinem?ticos de cada membro inferior durante a marcha; 3) Analisar os efeitos do treinamento em esteira com e sem adi??o de carga ao MINP sobre as medidas de mobilidade funcional e equil?brio postural desses pacientes. Materiais e M?todos: Trata-se de um ensaio cl?nico randomizado e simples cego, no qual participaram 38indiv?duos, com m?dia de idade de 56,5 anos, na fase subaguda p?s-AVC (tempo m?dio de sequela de 4,5 meses). Os participantes foram distribu?dos aleatoriamente em grupo experimental (GE) e grupo controle (GC). O GE (n= 19) foi submetido ao treino de marcha em esteira com adi??o de carga ao MINP, feita por meio de caneleiras com carga equivalente a 5% do peso corporal. O GC (n= 19) foi submetido somente ao treino de marcha em esteira. Em ambos os grupos, tamb?m foram aplicadas estrat?gias comportamentais, que inclu?am exerc?cios domiciliares. As interven??es ocorreram diariamente durante duas semanas consecutivas (Dia 1 ao Dia 9), com dura??o de 30 minutos cada. As medidas de desfecho: equil?brio postural (Escala de Equil?brio funcional de Berg - EEB), mobilidade funcional (Timed Up and Go - TUG; vari?veis cinem?ticas do movimento de giro de 180?), vari?veis cin?ticas e cinem?ticas da marcha e coordena??o dos membros inferiores (Teste para Coordena??o dos Membros Inferiores - LEMOCOT) foram avaliadas na linha de base (Dia 0), ap?s quatro sess?es de treinamento (Dia 4), ap?s nove sess?es de treinamento (Dia 9) e ap?s 40 dias do t?rmino dos treinamentos (Follow-up). Os par?metros cardiovasculares foram avaliados em quatro momentos dentro de cada sess?o de treinamento. An?lise de vari?ncia (ANOVA) foi utilizada para comparar os desfechos entre o GE e o GC no decorrer do estudo (Dia 0, Dia 4, Dia 9 e Follow-up). Testes t n?o-pareados permitiram a compara??o intergrupos em cada sess?o de treinamento. Em todos os testes, a signific?ncia foi estabelecida em 5%. Resultados: 1) Os par?metros cardiovasculares n?o sofreram altera??es ap?s as interven??es e n?o houve diferen?as entre os grupos dentro de cada sess?o de treinamento. Houve melhora da performance da marcha, com aumento da velocidade e da dist?ncia percorrida, sem diferen?a estatisticamente significante entre os grupos. 2) Ap?s as interven??es, os pacientes aumentaram o comprimento do passo par?tico e n?o par?tico, al?m de exibirem maior excurs?o articular no quadril e joelho de ambos os membros inferiores. Os ganhos foram observados no GE e GC, sem diferen?a estat?stica entre os grupos e mantidos (em sua maioria) no follow-up. 3) Ap?s as interven??es, os pacientes exibiram melhor equil?brio postural (maiores escores na EEB) e mobilidade funcional (redu??o do tempo gasto no teste TUG e melhora da performance do movimento de giro de 180?). Todos os ganhos foram observados no GE e GC, sem diferen?a estatisticamente significativa entre os grupos e foram mantidos no follow-up. Conclus?es: A adi??o de carga ao MINP n?o alterou os par?metros cardiovasculares de indiv?duos com AVC subagudo, semelhante ao treino em esteira sem carga, mostrando-se um treinamento seguro a ser aplicado nestes pacientes. Entretanto, o uso da carga n?o ocasionoubenef?cios adicionais ao treinamento de marcha. O programa de treinamento de marcha (nove sess?es de treino em esteira + estrat?gias e exerc?cios para estimula??o do membro par?tico) mostrou-se ?til para melhora da performance e da cinem?tica da marcha, da mobilidade funcional e do equil?brio postural, sendo sugerida a sua utiliza??o com o intuito de promover a otimiza??o desses desfechos ap?s AVC na fase subaguda. / Introduction: Gait after stroke is characterized by a significant asymmetry between the lower limbs, with predominant use of the non-paretic lower limb (NPLL) over using the paretic lower limb. Accordingly, it has been suggested that adding load/weight to the NPLL as a form of restricting the movement of this limb may favor the use of the paretic limb, reducing interlimb asymmetry. However, few studies have been conducted up to this moment, which only investigated the immediate effects of this practice. Objectives: 1) Investigating whether there is an influence of adding load to the NPLL during treadmill training on cardiovascular parameters and on gait performance of individuals with stroke, compared to treadmill training without load addition; 2) Analyzing the effects of treadmill training with and without load added to the NPLL on kinematic parameters of each lower limb during gait; 3) Analyzing the effects of treadmill training with and without load added to the NPLL on measurements of functional mobility and postural balance of these patients. Materials and Methods: This is a randomized single blinded clinical trial involving 38 subjects, with a mean age of 56.5 years, at the subacute post-stroke phase (with mean time since stroke of 4.5 months). Participants were randomly assigned into an experimental group (EG) or control group (CG). EG (n= 19) was submitted to gait training on a treadmill with the addition of load to the NPLL by ankle weights equivalent to 5% of body weight. CG (n= 19) was only submitted to gait training on a treadmill. Behavioral strategies which included home exercises were also applied to both groups. The interventions occurred daily for two consecutive weeks (Day 1 to Day 9), being of 30 minutes duration each. Outcome measures: postural balance (Berg Functional Balance Scale ? BBS), functional mobility (Timed Up and Go ? TUG; kinematic variables of 180? turning) and kinematic gait variables were assessed at baseline (Day 0), after four training sessions (Day 4), after nine training sessions (Day 9), and 40 days after completion of training (Follow-up). Cardiovascular parameters (mean arterial pressure and heart rate) were evaluated at four moments within each training session. Analysis of variance (ANOVA) was used to compare outcomes between EG and CG in the course of the study (Day 0, Day 4, Day 9 and Follow-up). Unpaired t-tests allowed for intergroup comparison at each training session. 5% significance was used for all tests. Results: 1) Cardiovascular parameters (systemic arterial pressure, heart rate and derivated variables) did not change after the interventions and there were no differences between groups within each training session. There was an improvement in gait performance, with increased speed and distance covered, with no statistically significant difference between groups. 2) After the interventions, patients had increased paretic and non-paretic step lengths, in addition to exhibiting greater hip and knee joint excursion on both lower limbs. The gains were observed in the EG and CG, with no statistical difference between the groups and (mostly) maintained at follow-up. 3) After the interventions, patients showed better postural balance (higher scores on BBS) and functional mobility (reduced time spent on the TUG test and better performance on the 180? turning). All gains were observed in the EG and CG, with no statistically significant difference between groups and were maintained at follow-up. Conclusions: The addition of load to the NPLL did not affect cardiovascular parameters in patients with subacute stroke, similar to treadmill training without load, thus seemingly a safe training to be applied to these patients. However, the use of the load did not bring any additional benefits to gait training. The gait training program (nine training sessions on a treadmill + strategies and exercises for paretic limb stimulation) was useful for improving gait performance and kinematics, functional mobility and postural balance, and its use is suggested to promote the optimization of these outcomes in the subacute phase after stroke.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/21276 |
| Date | 10 May 2016 |
| Creators | Ribeiro, Tatiana Souza |
| Contributors | 84091193404, http://lattes.cnpq.br/6535678775361874, Clementino, Adriana Carla Costa Ribeiro, 69118256449, http://lattes.cnpq.br/2549284887725210, Barela, Ana Maria Forti, 13422691871, http://lattes.cnpq.br/2481128022542270, Cavalcanti, Fabricia Azevedo da Costa, 00847101444, Cacho, Roberta de Oliveira, 21919190813, http://lattes.cnpq.br/9802587696943482, Lindquist, Ana Raquel Rodrigues |
| Publisher | Universidade Federal do Rio Grande do Norte, PROGRAMA DE P?S-GRADUA??O EM FISIOTERAPIA, UFRN, Brasil |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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