ABSTRACT
The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.
As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderência ao uso de medicamentos, cuidados paliativos, o futuro da reabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.
Subject(s)
Stroke Rehabilitation , Stroke , Humans , Brazil , COVID-19 , Stroke/complications , Stroke/drug therapy , Stroke Rehabilitation/methods , Randomized Controlled Trials as Topic , Meta-Analysis as Topic , Systematic Reviews as TopicABSTRACT
Abstract The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.
Resumo As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderênciaao usode medicamentos, cuidados paliativos,ofuturodareabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.
ABSTRACT
Objective: In people with chronic stroke, we investigated the transfer of gains obtained after balance training with virtual reality (VR) to an untrained task with similar balance demands. Materials and Methods: This study included 29 people with chronic stroke randomized into two groups: experimental (EG, n = 16) and control (CG, n = 13). The EG performed three sessions of balance training with VR using a platform-based videogame (Nintendo Wii Fit system™) for 1 week. The CG received no intervention. Transfer was evaluated through balance tests on the force platform Balance Master™, performed before and after the intervention period, for both groups. Results: The analysis of variance for repeated measures for game performance in the EG showed statistically significant improvement in scores in all five games after training (AT). In contrast, similar analysis for balance tests for the EG and CG showed no significant differences in performance index scores derived from the Balance Master tests after the intervention period for both groups. Conclusion: People with chronic stroke showed performance improvement AT with VR, but there was no transfer of the gains obtained to an untrained task with similar balance demands.
Subject(s)
Postural Balance , Stroke Rehabilitation/instrumentation , Virtual Reality , Adult , Female , Humans , Male , Middle Aged , Physical Functional Performance , Stroke/complications , Stroke/psychology , Stroke Rehabilitation/methods , Stroke Rehabilitation/standardsABSTRACT
Few studies have described physical therapy approaches to provide functional independence and reduce pain in individuals with dystonia. This report describes the physical therapy treatment of a 46-year-old woman diagnosed with idiopathic segmental axial dystonia. For two years, the patient was treated with kinesiotherapy (active and resisted movements and stretching of neck and trunk muscles), abdominal taping (kinesiotaping techniques), functional training, and sensory tricks. She was assessed with parts I, II and III of Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS-I, TWSTRS-II and TWSTRS-III), Berg Balance Scale (BBS), Six-Minute Walk Test (6-MWT), and the motor domain of Functional Independence Measure (FIM-motor) before and after the two-year treatment and after the one year follow-up. Postural control and symmetry improved (TWSTRS-I: from 30 to 18), functional independence increased (TWSTRS-II: from 27 to 15; BBS: from 36 to 46; 6-MWT: from 0 to 480 meters (m); FIM-motor: from 59 to 81), and the pain diminished (TWSTRS-III: from 12 to 5). The functional improvement was retained after one year (TWSTRS-I: 14/35; TWRTRS-II: 12/30; TWRTRS-III: 5/20; BBS: 48/56; 6-MWT: 450 m; FIM-motor: 81/91). This program showed efficacy on providing a better control of the dystonic muscles and thus the doses of botulinum toxin needed to treat them could be reduced. Outcomes support the therapeutic strategies used to deal with this type of dystonia.
Subject(s)
Abdominal Muscles/physiopathology , Back Muscles/physiopathology , Neck Muscles/physiopathology , Physical Therapy Modalities , Torticollis/therapy , Adaptation, Physiological , Anti-Dyskinesia Agents/therapeutic use , Athletic Tape , Biomechanical Phenomena , Botulinum Toxins/administration & dosage , Disability Evaluation , Exercise Movement Techniques , Exercise Test , Female , Humans , Kinesthesis , Middle Aged , Muscle Stretching Exercises , Pain Measurement , Physical Therapy Modalities/instrumentation , Posture , Range of Motion, Articular , Recovery of Function , Severity of Illness Index , Time Factors , Torticollis/diagnosis , Torticollis/physiopathology , Treatment OutcomeABSTRACT
OBJECTIVES: To investigate the effect of Nintendo Wii™-based motor cognitive training versus balance exercise therapy on activities of daily living in patients with Parkinson's disease. DESIGN: Parallel, prospective, single-blind, randomised clinical trial. SETTING: Brazilian Parkinson Association. PARTICIPANTS: Thirty-two patients with Parkinson's disease (Hoehn and Yahr stages 1 and 2). INTERVENTIONS: Fourteen training sessions consisting of 30 minutes of stretching, strengthening and axial mobility exercises, plus 30 minutes of balance training. The control group performed balance exercises without feedback or cognitive stimulation, and the experimental group performed 10 Wii Fit™ games. MAIN OUTCOME MEASURE: Section II of the Unified Parkinson's Disease Rating Scale (UPDRS-II). RANDOMISATION: Participants were randomised into a control group (n=16) and an experimental group (n=16) through blinded drawing of names. STATISTICAL ANALYSIS: Repeated-measures analysis of variance (RM-ANOVA). RESULTS: Both groups showed improvement in the UPDRS-II with assessment effect (RM-ANOVA P<0.001, observed power=0.999). There was no difference between the control group and the experimental group before training {8.9 [standard deviation (SD) 2.9] vs 10.1 (SD 3.8)}, after training [7.6 (SD 2.9) vs 8.1 (SD 3.5)] or 60 days after training [8.1 (SD 3.2) vs 8.3 (SD 3.6)]. The mean difference of the whole group between before training and after training was -0.9 (SD 2.3, 95% confidence interval -1.7 to -0.6). CONCLUSION: Patients with Parkinson's disease showed improved performance in activities of daily living after 14 sessions of balance training, with no additional advantages associated with the Wii-based motor and cognitive training. Registered on http://www.clinicaltrials.gov (identifier: NCT01580787).
Subject(s)
Activities of Daily Living , Exercise Therapy/methods , Parkinson Disease/rehabilitation , Physical Therapy Modalities , Video Games , Aged , Cognition , Female , Humans , Male , Middle Aged , Motor Skills , Parkinson Disease/physiopathology , Postural Balance , Prospective Studies , Single-Blind Method , Treatment Outcome , User-Computer InterfaceABSTRACT
OBJECTIVES: To evaluate the learning, retention and transfer of performance improvements after Nintendo Wii Fit™ training in patients with Parkinson's disease and healthy elderly people. DESIGN: Longitudinal, controlled clinical study. PARTICIPANTS: Sixteen patients with early-stage Parkinson's disease and 11 healthy elderly people. INTERVENTIONS: Warm-up exercises and Wii Fit training that involved training motor (shifts centre of gravity and step alternation) and cognitive skills. A follow-up evaluative Wii Fit session was held 60 days after the end of training. Participants performed a functional reach test before and after training as a measure of learning transfer. MAIN OUTCOME MEASURES: Learning and retention were determined based on the scores of 10 Wii Fit games over eight sessions. Transfer of learning was assessed after training using the functional reach test. RESULTS: Patients with Parkinson's disease showed no deficit in learning or retention on seven of the 10 games, despite showing poorer performance on five games compared with the healthy elderly group. Patients with Parkinson's disease showed marked learning deficits on three other games, independent of poorer initial performance. This deficit appears to be associated with cognitive demands of the games which require decision-making, response inhibition, divided attention and working memory. Finally, patients with Parkinson's disease were able to transfer motor ability trained on the games to a similar untrained task. CONCLUSIONS: The ability of patients with Parkinson's disease to learn, retain and transfer performance improvements after training on the Nintendo Wii Fit depends largely on the demands, particularly cognitive demands, of the games involved, reiterating the importance of game selection for rehabilitation purposes.
Subject(s)
Exercise Therapy/methods , Motor Skills , Parkinson Disease/rehabilitation , Video Games , Virtual Reality Exposure Therapy/methods , Aged , Aging , Cognition , Follow-Up Studies , Humans , Longitudinal Studies , Middle Aged , Parkinson Disease/physiopathology , Physical Therapy Modalities , Postural Balance , Treatment OutcomeABSTRACT
A realização de exercícios físicos para pacientes com sequelas motoras pós-acidente vascular encefálico (AVE) é essencial para a recuperação funcional. Programas educacionais podem facilitar a repetição dos exercícios em casa e contribuir para o tratamento. Este trabalho teve como objetivo elaborar e aplicar um manual de exercícios domiciliares para pacientes com AVE. O estudo consistiu em duas etapas: na primeira foi elaborado um manual de exercícios domiciliares (piloto) com fotos e textos simples para facilitar a compreensão. Foi realizada uma avaliação funcional de cada paciente e selecionados os exercícios mais adequados, que deveriam ser feitos em casa. Esse manual foi aplicado a 17 pacientes, 70% crônicos e 30% agudos. Após 15 dias, o paciente retornava e era solicitado que reproduzisse os exercícios e informasse o nível de compreensão das fotos e do texto do manual e se sentia dor ao realizá-los. As fotos e os exercícios referidos como difíceis foram revistos, e criada a versão teste que foi aplicada em outros 23 pacientes, dando origem à versão final do manual. A avaliação do manual piloto foi insatisfatória, sendo que apenas 56% referiram aprovação das fotos e 87% do texto. Após a reformulação, a compreensão das fotos e do texto alcançou valores acima de 98%. Foi possível obter um manual ilustrado de exercícios domiciliares, de fácil aplicação e compreensão, específico e individualizado, para pacientes com AVE e adaptável aos diferentes quadros motores.
The practice of exercises for patients with motor sequels post-stroke is essential for the functional recovery. Educational programs can facilitate the repetition of the exercises at home and contribute to the treatment. The objective of this study was to elaborate a home exercise manual for stroke patients. The study consisted of two stages: in the first one, a home exercise manual was made (pilot) with pictures and simple text to facilitate understanding. We made functional assessment of each patient and select the most appropriate exercises that everyone should do at home. This manual has been applied to 17 patients, 70% chronic and acute 30%. After 15 days the patient returned and was asked to reproduce the exercises and report the level of understanding of pictures and text of the manual and if felt pain in perform them. Photos and exercises reported such as difficult were reviewed and created a test version that was applied in another 23 patients resulting in the final version of the manual. The evaluation of the manual pilot was unsatisfactory, with only 56% reported approval of photos and 87% approval of text. After reformulation, the comprehension of the photos and text reached values above 98%. It was possible to obtain an illustrated manual of home exercises, easy understanding and application specific and personal for stroke patients and adaptable for different motor conditions.
Subject(s)
Humans , Male , Female , Stroke/rehabilitation , Health Education , Home Nursing , Physical Therapy Modalities , Paresis/rehabilitation , Resource GuideABSTRACT
A Síndrome de Pusher (SP) é uma alteração perceptual presente em 10% dos casos de hemiparesia causada por Acidente Vascular Encefálico (AVE). Caracteriza-se por queda para o lado parético, comportamento de empurrar-se para o lado acometido com o hemicorpo não parético e resistência à correção externa. Este estudo visou descrever a avaliação, o tratamento e a evolução de uma paciente com hemiparesia à esquerda e SP, devido a um AVE no hemisfério cerebral direito. Seis meses após a lesão, a paciente realizou testes perceptuais (do desenho da figura humana, comportamental de inatenção, escala de avaliação do sintoma de empurrar, miniexame do estado mental) e de desempenho funcional (escala de avaliação postural para pacientes com AVE, teste de função manual de Jebsen-Taylor, medida de independência funcional e índice de Barthel) e iniciou fisioterapia duas vezes por semana. Cada sessão teve 3 partes de 20 minutos: estimulação sensorial, treino motor e integração sensório-motora. Após o tratamento a paciente foi reavaliada e apresentou melhora em todas as escalas. A de avaliação do sintoma de empurrar e o teste de função manual de Jebsen-Taylor foram os que registraram maiores percentuais de melhora, 79% e 46%, respectivamente. O protocolo utilizado, mesmo tendo sido iniciado seis meses após a lesão, proporcionou melhora perceptual e funcional, o que sugere a importância da fisioterapia na recuperação da SP.
The Pusher´s Syndrome (PS) is a perceptual disorder that occurs in 10% of the cases of hemiparesis caused by stroke. It is characterized by falling to the paretic side, pushing to the paretic side with the non-paretic side and resisting to external correction. The present study aimed to describe the assessment, treatment and clinical evolution of a patient with left paresis and PS, caused by a stroke on the right hemisphere. Six months after the lesion, the patient was submitted to perceptual (human figure drawing test, behavioral inattention test, scale for contraversive pushing, minimental state examination) and functional performance tests (postural assessment stroke scale, Jebsen-Taylor hand function test, functional independence measure and Barthel index) and started physical therapy twice a week. Each session consisted of 3 parts of 20 minutes: sensory stimulation, motor training and sensory-motor integration. After six months, the patient showed improvement in all scales. The scale for contraversive pushing and the Jebsen-Taylor hand function test showed the highest percentages of improvement, 79% and 46%, respectively. Besides having been started six months after the lesion, the protocol of the present study contributed to the improvement of perception and functional performance. These findings suggest the importance of the physical therapy treatment in the recovery of individuals with PS.
Subject(s)
Humans , Female , Aged , Manipulation, Chiropractic , Physical Therapy Modalities , Postural Balance , Perceptual Disorders/rehabilitationABSTRACT
Ratos Wistar machos tiveram acesso à roda de corrida por 7 períodos de 12 horas antes da lesão. Animais controles sedentários permaneceram em caixas individuais desprovidas de roda, nas mesmas situações. Após, os animais treinados e controles sedentários foram submetidos à lesão estereotáxica isquêmica por injeção de endotelina-1 (ET-1, 2µg) no corpo estriado. Parte do grupo de animais controles sedentários foi submetido à injeção estereotáxica do solvente. Após a cirurgia, os animais treinados foram divididos em dois grupos: treinado interrompido (permaneceram em caixas individuais desprovidas de roda) e treinado mantido (manutenção do protocolo de atividade física). Os animais foram semanalmente submetidos à análise do comportamento motor espontâneo por sistema automatizado de emissão de luz infravermelha. Após 14 ou 30 dias da lesão, os animais foram sacrificados e seus cérebros processados para imunohistoquímica da OX42 (marcador de microglia), da proteína fibrilar ácida glial (GFAP, marcador de astrócitos), da proteína associada ao microtúbulo-2 (MAP-2, marcador de dendritos), da tirosina hidroxilase (TH, marcador de células e fibras dopaminérgicas) e do fator básico de crescimento fibroblástico (bFGF ou FGF-2, um fator neurotrófico). As marcações foram quantificadas por método de análise de imagem ou estereologia. A atividade física espontânea promoveu melhor desempenho motor antes da lesão e diante da manutenção do treino após a lesão. A cicatriz microglial ao redor da área de injeção estriatal de ET-1 diminuiu em função da atividade física espontânea mantida ou interrompida no grupo de 14 dias, entretanto, a reação microglial adjacente à lesão só foi maior no grupo sedentário, aos 14 dias de...(AU)
