FISIOTERAPIA HEMIPLEGIA PDF
Abstract. Objetive: to perform a literature review on the effectiveness of aquatic therapy in the treatment of hemiplegic patient rehabilitation to help the disclosure . 29 abr. Tipos de Hemiplegia Características Causas Tratamento Os objetivos da Fisioterapia Hemiplegia Hemiplegia Homolateral Hemiplegia espinal. Hemiplegia com predomínio braquial (E). Adaptação para adutores (E) durante Mecanoterapia de Membros Inferiores. #Neurofuncional #Fisioterapia #AVC.
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Individuals with stroke sequelae present changes in the postural alignment and muscle strength associated with hemiplegia or hemiparesis.
Mirror therapy for upper limb rehabilitation in chronic patients after stroke
Mirror therapy is a technique that aims to improve the motor function of the paretic limb. The aim of this study was to evaluate the effect of mirror therapy, associated with conventional physiotherapy, for range of motion ROMdegree of spasticity of the affected upper limb, and hemoplegia level of independence in the activities of daily living ADL of chronic patients after stroke.
This was a quasi-experimental before and after study. The study included ten stroke survivors undertaking physiotherapy and presenting with upper limb paresis. The following gauges were used for the present study: Fifteen sessions were performed, each lasting 30 minutes, consisting of stretching of the flexor and extensor muscles of the wrist hemiplegka elbow, pronators and supinators, followed by mirror therapy with gradual functional exercises. It can be concluded that mirror therapy contributed to the participants’ good performance in the aspects studied, mainly in relation to ROM of the affected upper limb.
Trata-se de um estudo quase experimental do tipo antes e depois. The term stroke is used to define a neurological, transient or permanent deficit in a cerebral area, secondary to vascular injury, of an ischemic or hemorrhagic etiology 12.
In the early stages fisioterzpia a stroke, cerebral edema is verified, along with the consequent impairment of the cortico-spinal pathway, which is responsible for the transmission hemiplegi motor commands.
The absence of moving will provide to the brain a negative visual feedback which generates a form of paralysis learned 345.
Stroke is currently considered to be a public health problem, having a high incidence, and being one of the major causes of chronic disability in the world, and the most significant health problem in Latin America 6. Patient recovery after this kind of injury is related to neural plasticity. A specific task of motor learning can be an important stimulus to promote neuroplasticity and to correct pathological patterns after stroke 4789. Mirror therapy, or visual mirror feedback, is a noninvasive technique that aims to improve the motor function of the affected limb 10 It consists of performing movements with the healthy limb in front of a mirror that is positioned at the body’s midline.
The patient visualizes the “false” movement of the affected limb. It was first described by Ramachandran and Rogers, infor the reduction of phantom limb pain in amputees Years later, inAltschuler and colleagues conducted a pilot study, with the same technique, to stimulate the movements of the hemiparetic limb of patients after stroke 5 The movements of the healthy limb reflected in the mirror transmit the perception that the affected limb is moving, thus generating a positive visual feedback that competes against the negative visual feedback generated at the time of clinical onset of the stroke 3.
The mirror neurons are recruited in this therapy. These neurons, located in both the frontal and in the parietal lobes, involve interactions between multiple modalities vision, motor commands and proprioceptionand are triggered when there occurs the performance of simple, skillful movements, or when one observes someone else performing the same movement 35 The movements of the unaffected limb change the excitability of the ipsilateral motor cortex, and benefit the function of the affected limb.
According to Lameira et al. Considering the lack of studies on this subject, this study aimed to evaluate the effect of mirror therapy as an additional treatment to conventional therapy, functional mobility, degree of spasticity of the affected upper limb, and the level of independence of the activities of daily living ADL after stroke.
This research is a quasi-experimental study, of the before and after type. The study included patients with some type of limitation in functional abilities and active range of motion of the wrist and elbow. Patients with a wrist or elbow deformity that restricted the possibility of functional improvements were excluded, as well as those with other associated neurological injuries or illnesses that limited joint mobility, or patients who presented cognitive or visual impairments that prevented the understanding of the commands and their cooperation with those commands.
The participants were previously assessed for their range of motion ROM for flexion and extension of the wrist and elbow, and pronation-supination of the forearm, using the Carci r brand goniometer 16 ; the modified Ashworth scale was used to evaluate the extent of spasticity 17 ; the functionality of the affected upper limb was assessed using the Fulg-Meyer scale 1819 ; and, the level of independence in ADL was evaluated using the Barthel index The patients were reassessed after 15 intervention sessions.
The intervention consisted of muscle stretching and mirror therapy.
Hemiplegia by Carolina Miranda on Prezi
The stretches were performed at the beginning of each session, in the flexor and extensor muscles of the wrist and elbow, and pronators and supinators of the forearm of the healthy and paretic upper limb, in two sets of 30 seconds each Then, mirror therapy was performed to the healthy upper limb, which was made up of graduated functional exercises, according to their complexity.
The exercise protocol was based on exercises found in the literature, aiming for the functionality of the activities 1422and can be seen in Table 1. The evaluations and interventions proposed were performed by Researcher A, and the reassessment by Researcher B, who did not have access to the data previously obtained.
For analysis purposes, a probability distribution was performed percentage analysis. Subsequently, the hemiplgia distribution and homogeneity of fisioteerapia techniques were applied using Shapiro Wilks and Bartlett testing, respectively. The non-parametric Wilcoxon test was used. As shown in Figure 128 patients eligible to participate in the study were selected.
The results of the dimension functionality of the upper limb using the Fulg-Meyer scale, before and after the intervention, are shown in Table 3.
As for spasticity, no statistically significant hemiplehia before and after the intervention proposal were identified. The Barthel index scores are shown in Table 4. An increase in ROM for most analyzed movements was observed after the intervention; however, only the wrist extension and forearm supination movements showed considerable significance.
Mirror therapy has been studied in various aspects of rehabilitation in patients after a stroke, especially in relation to the recovery of ROM of affected limbs. An increase in upper limb functionality affected after the intervention was identified in this study using the Fulg-Meyer scale, but without statistical significance.
Similar results using the same scale were identified in the study by Steves and Stoykov Souza, Rangel and Silva 25verified improvement in functional independence in activities of daily living ADL and also in motor function through a case study with six patients, who performed ten sessions with mirror therapy. We believe that the fact that these patients were already classified as chronic, due to time of injury, may also have influenced the functional response obtained in this study, as well as the small sample size due to losses by refusal; however, we believe that despite not achieving statistical significance, the results were hemippegia and clinically important.
Regarding spasticity, no improvement was found with implementation of this technique, and these results corroborate other literature.
Similar results were found in the study of Yavuzer et al. Later, corroborating the above-mentioned result, Yun et al. The ineffectiveness fisioterapa the technique on spasticity can be attributed to the fact that mirror therapy does not act directly on the muscle spindles, which is fundamental for its reduction by slowing the nervous signaling transmission. The treatments classically recommended for reducing spasticity, such as strengthening of the antagonist muscle, cryotherapy and botulinum toxin application, act directly on the muscle spindle, decreasing excitability 2728 In relation to the ADL, as measured by the Barthel index, patients showed improvement in the individual score, but the hemiplegiia was not enough to provide change in the functional category, given that the Barthel index results are interpreted in categories ranging from total dependence to independence of the patient.
Later, Ietswaart et al. Stroke is a clinical syndrome in which the patient may progress toward extensive motor impairment, such as spasticity, muscle shortening, fatigue, biomechanical and functional changes, and, consequently, a decreased quality of life.
Thus, performance of physiotherapy and the inclusion of new techniques in clinical practice that may help with motor rehabilitation of these patients, become increasingly important. The recovery of the ROM and upper limb function is a major concern during the patient’s rehabilitation after stroke.
The use of mirror therapy for the recovery of patients after stroke is recent, and there are few controlled studies with representative sample numbers. According to the results obtained in this study, it can be concluded that the mirror therapy, in combination with conventional physiotherapy, contributed to the good performance of the volunteers participating in this research, especially in relation to the recovery of ROM of the affected upper limb.
Given these results, it hemillegia believed that increasing the sample size would provide better results in the remaining aspects studied. More studies with larger numbers of participants, and controlled group training must be conducted to prove the effectiveness this technique. Swallowing disorders after ischemic stroke.
The use of visual feedback, in particular mirror visual feedback, in restoring brain function. Rev Panam Salud Publica. Universidade Fernando Pessoa; Borella MP, Sacchelli T. Eur J Phys Rehabil Med. Synaesthesia in phanthom limbs induced with mirrors.
Proc R Soc Lond B. Rehabilitation of hemiparesis after stroke with a mirror. Reflections on Mirror Therapy: Mitos e verdades sobre flexibilidade: Using Motor Imagery in the Rehabilitation of Hemiparesis. Arch Phys Med Rehabil. Mirror therapy enhances upper extremity motor recovery in stroke patients. A Randomized Controlled Trial. Mental practice with motor imagery in stroke recovery: This is an open-access article distributed under the terms of the Creative Commons Attribution License.
Services on Demand Journal. Original Articles Mirror therapy for upper limb rehabilitation in chronic patients after stroke. Introduction The term stroke is used to define a neurological, transient or permanent deficit in a cerebral area, secondary to vascular injury, of an ischemic or hemorrhagic etiology 12. Material and methods This research is a quasi-experimental study, of the before and after type. Results As shown in Figure 128 patients eligible to participate in the study were selected.
Discussion An increase in ROM for most analyzed movements was observed after the intervention; however, only the wrist extension and forearm supination movements showed considerable significance.
Conclusion Stroke is a clinical syndrome in which the patient may progress toward extensive motor impairment, such as spasticity, muscle shortening, fatigue, biomechanical and functional changes, and, consequently, a decreased quality of life. June 20, ; Accepted: How to cite this article.