ABSTRACT
Since the first Broca publications issued from 1970s, lateralized functions in the human brain have urged the researchers to postulate hypothesis based in the right-left asymmetries and, according to some theories, the lateralization of the voluntary motor control could represent a solution to avoid redundant process optimizing space and time. Supported by this idea, the clinicians and researchers tend to concept that the chronic hemiplegic stroke patients learn to use predominantly the non-affected hemibody after stroke in which is more convenient to execute their daily life activities, modifying their natural preference in some cases. Although could seems reasonable conceptualize the non-affected side as the predominantly-used hemibody for motor tasks after stroke (convenience hypothesis), evidences point to exist also hemiplegic patients that developed a predominantly use of the affected side. To float an idea, in terms of weight bearing distribution during upright position, the researchers have found patients overloading the non-affected hemibody, as expected; but also patients overloading the affected hemibody, not presenting necessarily Pusher's syndrome cases. Given the evidences, we could propose a severity-modulated predominance hypothesis which complements the convenience hypothesis. According to our complementary hypothesis, the severity of the motor disability presented in the hemiparesis condition (light, moderate and heavy severity) could determine a predominant use defined by preference (light to moderate severity) or convenience (moderate to heavy severity). In this hypothesis, we postulate ideas from a rehabilitation perspective to be incorporated in treatment programs.
Subject(s)
Paresis/physiopathology , Stroke/physiopathology , Chronic Disease , HumansABSTRACT
INTRODUCTION: Although baropodometric analysis has been published since the 1990s, only now it is found a considerable number of studies showing different uses in the rehabilitation. OBJECTIVE: To amplify the use of this technology, this research aimed to analyze baropodometric records during upright position of subjects with hemiparesis, describing a way to define weight-bearing profiles in this population. METHOD: 20 healthy subjects were matched by gender and age with 12 subjects with chronic spastic hemiparesis. This control group was formed to establish the limits of symmetry during weight-bearing distribution in the hemiparesis group. Next, hemiparesis group was submitted to procedures to measure baropodometric records used to provide variables related to the weight-bearing distribution, the arch index and the displacements in the center of pressure (CoP). Data were used to compare differences among kinds of weight-bearing distribution (symmetric, asymmetric toward non-paretic or paretic foot) and coordination system for CoP displacements. RESULTS: Hemiparesis group was compounded by eight symmetrics, eight asymmetrics toward non-paretic foot and four asymmetric toward paretic foot. Significant differences in the weight-bearing distributions between non-predominantly and predominantly used foot did not promote differences in the other baropodometric records (peak and mean of pressure, and support area). Mainly in the asymmetry toward non-paretic foot it was observed significant modifications of the baropodometric records. CONCLUSION: Baropodometric technology can be used to analyze weight-bearing distribution during upright position of subjects with hemiparesis, detecting different kinds of weight-bearing profiles useful to therapeutic programs and researches involving subjects with this disability.
INTRODUÇÃO: Embora análises baropodométricas sejam encontradas desde a década de 1990, somente agora é observado número considerável de estudos mostrando usos na reabilitação. OBJETIVOS: Para ampliar o uso dessa tecnologia, objetivou-se analisar registros baropodométricos durante a posição ortostática de sujeitos com hemiparesia, descrevendo o suporte de peso nessa população. MÉTODOS: 20 sujeitos saudáveis foram pareados por gênero e idade com 12 sujeitos com hemiparesia espástica crônica. Controles foram formados para estabelecer limites de simetria na distribuição do suporte de peso no grupo hemiparesia. Em seguida, o grupo hemiparesia foi submetido a procedimentos usados para fornecer variáveis como: distribuição no suporte de peso, índice de arqueamento e deslocamentos no centro de pressão (CoP). Os dados diferenciaram tipos de distribuição do suporte de peso (simétrico, assimétrico em direção ao pé não parético ou parético) e estabeleceram sistemas de coordenadas para deslocamentos do CoP. RESULTADOS: O grupo hemiparesia apresentou oito simétricos, oito assimétricos em direção ao pé não parético e quatro em direção ao pé parético. Distribuição assimétrica do suporte entre os pés não predominantemente ou predominantemente usados não promoveram diferenças em registros baropodométricos (pico e média de pressão e área de suporte). Principalmente para a assimetria em direção ao pé não parético, observou-se modificações significativas nos registros baropodométricos. CONCLUSÃO: Tecnologia baropodométrica pode ser usada para analisar a distribuição no suporte de peso durante a posição ortostática de sujeitos com hemiparesia, detectando diferentes tipos de suporte de peso, úteis para serem usados em programas terapêuticos e em pesquisas envolvendo sujeitos com essa incapacidade.
