Efeitos da utilização da realidade virtual não imersiva na reabilitação de membro superior de pacientes acometidos por AVC em um hospital público de Porto Alegre / Non-immersive virtual reality effects on upper limb rehabilitation of patients with stroke in a public hospital in Porto Alegre

O presente estudo teve por objetivo relatar os efeitos do uso da realidade virtual não imersiva através de um jogo criado para a reabilitação de membro superior pós AVC. O mesmo foi aplicado com quatro pacientes na Unidade de Cuidados Especiais do Hospital de Clínicas de Porto Alegre, sendo realizado duas vezes ao dia durante a semana e uma vez ao dia nos finais de semana, desde a avaliação ao momento da alta hospitalar. Foi realizado a avaliação inicial e final da escala de Rankin modificada e selecionou-se as jogadas inicial e final para a verificação dos resultados. A análise dos dados foi realizada através de estatística descritiva. Os resultados demonstraram uma diminuição do tempo de execução do jogo com aumento da pontuação alcançada durante os desafios na maioria dos pacientes. Entende-se que jogos sérios podem ser utilizados como complemento na reabilitação pós-AVC. (AU)

The present study aimed to report the effects of using a non-immersive virtual reality game on patients undergoing upper limb rehabilitation after stroke. The intervention was administered to 4 patients in the Special Care Unit at Hospital de Clínicas de Porto Alegre; it was performed twice a day during the week and once a day on weekends, from baseline to discharge. The initial and final evaluations were conducted using the modified Rankin scale, and the initial and final moves were selected to check the results. Data analysis was performed using descriptive statistics. The results showed a decrease in game execution time with an increase in the score achieved during the challenges in most patients. It is believed that serious games can be used as an additional tool in post-stroke rehabilitation. (AU)

Relationship between pulmonary function, functional independence, and trunk control in patients with stroke.

OBJECTIVE: Stroke often leads to abnormalities in muscle tone, posture, and motor control that may compromise voluntary motor function, thus affecting the motor control required for maintaining the synergy of both peripheral and respiratory muscles. To evaluate respiratory muscle strength, pulmonary function, trunk control, and functional independence in patients with stroke and to correlate trunk control with the other variables. METHODS: This was a cross-sectional study of patients diagnosed with stroke. We assessed respiratory muscle strength, trunk control as assessed by the Trunk Impairment Scale, spirometric variables, and the Functional Independence Measure. RESULTS: Forty-four patients were included. Pulmonary function and respiratory muscle strength were significantly lower than predicted for the study population, and the mean Trunk Impairment Scale score was 14.3 points. The following significant correlations were found between the variables: trunk control vs. maximal inspiratory pressure (r = 0.26, p < 0.05); trunk control vs. forced vital capacity (r = 0.28, p < 0.05); trunk control vs. forced expiratory volume in one second (r = 0.29, p < 0.05), and trunk control vs. the Functional Independence Measure (r = 0.77, p < 0.05). CONCLUSION: The present study showed that respiratory muscle strength, pulmonary function, functional independence, and trunk control are reduced in patients diagnosed with stroke.

Relationship between pulmonary function, functional independence, and trunk control in patients with stroke / Relação entre função pumonar, independência functional e controle de tronco em pacientes após acidente vascular cerebral

ABSTRACT Stroke often leads to abnormalities in muscle tone, posture, and motor control that may compromise voluntary motor function, thus affecting the motor control required for maintaining the synergy of both peripheral and respiratory muscles. Objective To evaluate respiratory muscle strength, pulmonary function, trunk control, and functional independence in patients with stroke and to correlate trunk control with the other variables. Methods This was a cross-sectional study of patients diagnosed with stroke. We assessed respiratory muscle strength, trunk control as assessed by the Trunk Impairment Scale, spirometric variables, and the Functional Independence Measure. Results Forty-four patients were included. Pulmonary function and respiratory muscle strength were significantly lower than predicted for the study population, and the mean Trunk Impairment Scale score was 14.3 points. The following significant correlations were found between the variables: trunk control vs. maximal inspiratory pressure (r = 0.26, p < 0.05); trunk control vs. forced vital capacity (r = 0.28, p < 0.05); trunk control vs. forced expiratory volume in one second (r = 0.29, p < 0.05), and trunk control vs. the Functional Independence Measure (r = 0.77, p < 0.05). Conclusion The present study showed that respiratory muscle strength, pulmonary function, functional independence, and trunk control are reduced in patients diagnosed with stroke.

RESUMO Acidente vascular cerebral (AVC) frequentemente leva a anormalidades no tônus muscular, postura e controle motor que podem comprometer a função motora voluntária, afetando o controle motor necessário para manter a sinergia dos músculos periféricos e respiratórios. Objetivo Avaliar a força muscular respiratória, a função pulmonar, o controle do tronco e a independência funcional em pacientes com AVC e correlacionar o controle do tronco com as demais variáveis. Métodos Este foi um estudo transversal, incluindo pacientes diagnosticados com AVC. Avaliamos a força muscular respiratória, o controle do tronco avaliado pela escala de comprometimento de tronco, as variáveis espirométricas e a medida de independência funcional. Resultados Quarenta e quatro pacientes foram incluídos. A função pulmonar e a força muscular respiratória foram significativamente menores do que o previsto para a população estudada, e o escore médio do escala de comprometimento de tronco foi de 14,3 pontos. As seguintes correlações significativas foram encontradas entre as variáveis: controle do tronco vs. pressão inspiratória máxima (r = 0,26, p <0,05); controle do tronco vs capacidade vital forçada (r = 0,28, p <0,05); controle do tronco versus volume expiratório forçado no primeiro segundo (r = 0,29, p <0,05) e controle do tronco vs. medida de independência funcional (r = 0,77, p <0,05). Conclusão O presente estudo demonstrou que a força muscular respiratória, a função pulmonar, a independência funcional e o controle do tronco estão diminuídos em pacientes diagnosticados com AVC.

Efeito do treino locomotor com suporte parcial de peso corporal na velocidade de marcha de um paciente na fase aguda após acidente vascular cerebral: estudo de caso / Effect of partial body-weight support locomotor training on gait speed of a patient with acute stroke: a case study

O treino locomotor com suporte parcial de peso corporal (SPPC) é uma abordagem que tem sido utilizada na reabilitação do AVC. Entretanto, não há consenso na literatura sobre sua eficácia frente à reabilitação tradicional. Portanto, o objetivo desse estudo foi avaliar o efeito do treino com SPPC na velocidade de marcha após AVC na fase aguda. Um paciente, sexo masculino, 52 anos, foi avaliado através do Índice de Motricidade (IM) e Teste de Caminhada de 10 metros (TC10m). Recebeu, durante 5 dias, sessões de fisioterapia de 30 minutos, com 15 minutos de treino de marcha com SPPC. Apresentou um aumento de 28 pontos no IM e de mais de 50% nas velocidades de marcha normal e rápida. O resultado corrobora com estudos que evidenciam a eficácia do treino com SPPC na melhora da velocidade de marcha após AVC na fase aguda. (AU)

Locomotor training with partial body-weight support (PBWS) has been used for some years in stroke rehabilitation. However, there is no consensus in the literature about its effectiveness compared to conventional rehabilitation. Thus, the aim of this study was to evaluate the effect of PBWS training on gait speed after acute stroke. A 52-year-old male patient was assessed through Motricity Index (MI) and 10-meter Walk Test (10MWT). He had 30-minute physical therapy sessions, with 15-minute gait training with PBWS, for 5 days. The patient showed an increase of 28 points in MI and of over 50% in normal and fast gait speeds. The results are consistent with previous studies that showed the effectiveness of PBWS training in improving gait speed in acute stroke. (AU)

Early mobilization in ischemic stroke: a pilot randomized trial of safety and feasibility in a public hospital in Brazil.

BACKGROUND: The effect of early mobilization after acute stroke is still unclear, although some studies have suggested improvement in outcomes. We conducted a randomized, single-blind, controlled trial seeking to evaluate the feasibility, safety, and benefit of early mobilization for patients with acute ischemic stroke treated in a public teaching hospital in Southern Brazil. This report presents the feasibility and safety findings for the pilot phase of this trial. METHODS: The primary outcomes were time to first mobilization, total duration of mobilization, complications during early mobilization, falls within 3 months, mortality within 3 months, and medical complications of immobility. We included adult patients with CT- or MRI-confirmed ischemic stroke within 48 h of symptom onset who were admitted from March to November 2012 to the acute vascular unit or general emergency unit of a large urban emergency department (ED) at the Hospital de Clínicas de Porto Alegre. The severity of the neurological deficit on admission was assessed by the National Institutes of Health Stroke Scale (NIHSS). The NIHSS and modified Rankin Scale (mRS, functional outcome) scores were assessed on day 14 or at discharge as well as at 3 months. Activities of daily living (ADL) were measured with the modified Barthel Index (mBI) at 3 months. RESULTS: Thirty-seven patients (mean age 65 years, mean NIHSS score 11) were randomly allocated to an intervention group (IG) or a control group (CG). The IG received earlier (p = 0.001) and more frequent (p < 0.0001) mobilization than the CG. Of the 19 patients in the CG, only 5 (26%) underwent a physical therapy program during hospitalization. No complications (symptomatic hypotension or worsening of neurological symptoms) were observed in association with early mobilization. The rates of complications of immobility (pneumonia, pulmonary embolism, and deep vein thrombosis) and mortality were similar in the two groups. No statistically significant differences in functional independence, disability, or ADL (mBI ≥85) were observed between the groups at the 3-month follow-up. CONCLUSIONS: This pilot trial conducted at a public hospital in Brazil suggests that early mobilization after acute ischemic stroke is safe and feasible. Despite some challenges and limitations, early mobilization was successfully implemented, even in the setting of a large, complex ED, and without complications. Patients from the IG were mobilized much earlier than controls receiving the standard care provided in most Brazilian hospitals.