Efeito de um programa de reabilitação usando realidade virtual na função do membro superior em pacientes com acidente vascular cerebral
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Data
2017-02-21
Autores
Gonçalves, Maicon Gabriel [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O Acidente Vascular Cerebral (AVC) é caracterizado como um déficit neurológico decorrente de uma lesão focal e aguda do sistema nervoso central. O AVC é a segunda causa de morte no Brasil e a principal causa de incapacidade crônica em adultos, gerando consequências sócio econômicas e redução da qualidade de vida, tornando um problema importante de saúde publica cada vez mais evidente a medida que a população vem envelhecendo. Afeta principalmente o membro superior e a realidade virtual (RV) vêm sendo desenvolvida com objetivo de restaurar a capacidade funcional dos indivíduos após AVC por ser uma intervenção fácil, interativa e de baixo custo. Alem de ser uma ferramenta promissora que induz a ativação cortical, mas não é estabelecida como esta ativação cortical aumentada pode auxiliar na função motora após o AVC. Objetivo: avaliar os efeitos da terapia por RV na função do membro superior na recuperação dos indivíduos após AVC e as características de neuroimagem na fase aguda como preditor de melhor resposta a essa terapia.Materiais e Método:Trata-se de um estudo clínico prospectivo para avaliar o efeito de um programa de terapia por realidade virtual em paciente com AVC, as características neurológicas iniciais foram coletadas por meio da Escala de AVC do NationalInstitutesof Health(NIHSS), Escala modificada de Rankin, Índice de Barthel e ScandinavianStrokeScale (SSS). As características funcionais do membro superior foram avaliadas por meio da Chedock-McMasterScale, teste de caixa e blocos e UpperLimb Motor AssessmentScale. A qualidade de vida será avaliada por meio da StrokeImpactScale (SIS 3.0).Foram utilizados os exames de tomografia computadorizada de alta resolução realizados durante o atendimento no Hospital das Clínicas da Faculdade de Medicina de Botucatu coletados na fase pós ictus nas tomografias de controle.Resultados: Foram estudados 18 pacientes (8 mulheres) com média de idade 55,5 ± 13,9 anos. Desses pacientes, 9 foram submetidos ao tratamento com reperfusão cerebral, sendo que 14 pacientes Resumo apresentaram déficit neurológico à direita. A independência funcional mostrou melhora após a intervenção (p=0,0001), as características funcionais e destreza do membro superior apresentaram melhora após intervenção (p= 0,0001), assim como a qualidade de vida dos pacientes (p=0,0001). O volume médio de lesões observadas entre os pacientes foi de 24172 ± 17302 mm3. A análise da relação entre estruturas observamos uma relação da substância branca com a funcionalidade e destreza no membro superior foi maior com a porção posterior cápsula interna. Conclusão:Com base nos resultados obtidos foi observado melhora significativa nas características clinicas e na função do membro superior, assim como melhora na percepção da qualidade de vida nos pacientes após AVC que realizaram RV.Os achados de neuroimagem mostraram que a RV atuou de forma positiva na função e destreza do membro superior, apresentando correlação com a substância branca, sendo que quanto maior a área lesionada pior o prognóstico motor dos indivíduos após AVC.
Introduction: Cerebral Vascular Accident (CVA) is characterized as a neurological deficit resulting from a focal and acute central nervous system injury. Stroke is the second leading cause of death in Brazil and the leading cause of chronic disability in adults, resulting in socioeconomic consequences and reduced quality of life, making a major public health problem increasingly evident as the population ages. Affects mainly the upper limb and virtual reality (VR) have been developed with the objective of restoring the functional capacity of individuals after stroke because it is an easy, interactive and low cost intervention. In addition to being a promising tool that induces cortical activation, but it is not established how this increased cortical activation may aid in motor function after stroke. Objective: to evaluate the effects of VR therapy on upper limb function in the recovery of individuals after stroke And neuroimaging characteristics in the acute phase as a predictor of better response to this therapy. Materials and Method: This is a prospective clinical study to evaluate the effect of a virtual reality therapy program on stroke patient, initial neurological characteristics Were collected through the NationalInstitutes of Health (NIHSS) Stroke Scale, Rankin Modified Scale, Barthel Index and ScandinavianStrokeScale (SSS). The functional characteristics of the upper limb were evaluated by means of the Chedock-McMasterScale, carton and block test and UpperLimb Motor AssessmentScale. Quality of life will be evaluated through StrokeImpactScale (SIS 3.0). High resolution computed tomography (CT) examinations were performed during the care at the Hospital das Clínicas of Botucatu Medical School, collected in the post-stroke phase on the control tomography. Results: We studied 18 patients (8 women) with mean age 55.5 ± 13.9 years. Of these patients, 9 were submitted to treatment with cerebral reperfusion, and 14 patients presented right neurological deficit. Functional independence showed improvement after intervention (p = 0.0001), functional characteristics and dexterity of the upper limb showed improvement after intervention (p = 0.0001), as well as patients' quality of life (p = 0.0001 ). The Abstract mean volume of lesions observed among the patients was 24172 ± 17302 mm3. The analysis of the relationship between structures we observed a relationship of white matter with functionality and dexterity in the upper limb was greater with the posterior portion internal capsule. Conclusion: On the basis of the results obtained, a significant improvement in the clinical characteristics and function of the upper limb was observed, as well as an improvement in the perception of the quality of life in patients after stroke who performed RV. The neuroimaging findings showed that the RV acted positively In the function and dexterity of the upper limb, presenting a correlation with the white matter, and the higher the lesion area the worse the motor prognosis of the individuals after stroke.
Introduction: Cerebral Vascular Accident (CVA) is characterized as a neurological deficit resulting from a focal and acute central nervous system injury. Stroke is the second leading cause of death in Brazil and the leading cause of chronic disability in adults, resulting in socioeconomic consequences and reduced quality of life, making a major public health problem increasingly evident as the population ages. Affects mainly the upper limb and virtual reality (VR) have been developed with the objective of restoring the functional capacity of individuals after stroke because it is an easy, interactive and low cost intervention. In addition to being a promising tool that induces cortical activation, but it is not established how this increased cortical activation may aid in motor function after stroke. Objective: to evaluate the effects of VR therapy on upper limb function in the recovery of individuals after stroke And neuroimaging characteristics in the acute phase as a predictor of better response to this therapy. Materials and Method: This is a prospective clinical study to evaluate the effect of a virtual reality therapy program on stroke patient, initial neurological characteristics Were collected through the NationalInstitutes of Health (NIHSS) Stroke Scale, Rankin Modified Scale, Barthel Index and ScandinavianStrokeScale (SSS). The functional characteristics of the upper limb were evaluated by means of the Chedock-McMasterScale, carton and block test and UpperLimb Motor AssessmentScale. Quality of life will be evaluated through StrokeImpactScale (SIS 3.0). High resolution computed tomography (CT) examinations were performed during the care at the Hospital das Clínicas of Botucatu Medical School, collected in the post-stroke phase on the control tomography. Results: We studied 18 patients (8 women) with mean age 55.5 ± 13.9 years. Of these patients, 9 were submitted to treatment with cerebral reperfusion, and 14 patients presented right neurological deficit. Functional independence showed improvement after intervention (p = 0.0001), functional characteristics and dexterity of the upper limb showed improvement after intervention (p = 0.0001), as well as patients' quality of life (p = 0.0001 ). The Abstract mean volume of lesions observed among the patients was 24172 ± 17302 mm3. The analysis of the relationship between structures we observed a relationship of white matter with functionality and dexterity in the upper limb was greater with the posterior portion internal capsule. Conclusion: On the basis of the results obtained, a significant improvement in the clinical characteristics and function of the upper limb was observed, as well as an improvement in the perception of the quality of life in patients after stroke who performed RV. The neuroimaging findings showed that the RV acted positively In the function and dexterity of the upper limb, presenting a correlation with the white matter, and the higher the lesion area the worse the motor prognosis of the individuals after stroke.
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Palavras-chave
Acidente vascular cerebral, Realidade virtual, Reabilitação