Avaliação da sarcopenia e déficits motores no lado ipsilateral em pacientes com infartos cerebrais unilaterais: implicações prognósticas na reabilitação
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Data
2017-08-23
Autores
Lima, Fabrício Diniz de [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O acidente vascular cerebral (AVC) é uma grave condição neurológica, que acomete pessoas do mundo inteiro, com elevada morbimortalidade e incapacidade funcional, tendo como principal manifestação o déficit motor, tornando a reabilitação imperativa. No entanto, alguns fatores comuns podem dificultar o sucesso da reabilitação, como a sarcopenia, que pode provocar prejuízo trófico e metabólico no hemicorpo denominado não afetado, correlacionando-se ao comprometimento funcional. Este trabalho busca avaliar alterações tróficas, metabólicas e funcionais no lado ipsilateral, em pacientes com AVC isquêmico, a fim de averiguar a correlação entre a sarcopenia e déficit funcional. Pacientes e métodos: Foram avaliados parâmetros antropométricos e morfológicos, realizados estudos de bioimpedância e executada a dinamometria em 21 pacientes com AVC isquêmico de circulação anterior em 2 momentos distintos: fases aguda (até 48 h após o ictus) e crônica (90 dias após o ictus). Resultados: 21 pacientes foram incluídos (57% do sexo masculino; média de idade de 67,09 anos, variando de 26 a 84 anos). Todos receberam avaliação contínua da equipe multiprofissional durante o estudo. Não houve redução estatisticamente significativa da massa muscular, quantidade de proteína, água, minerais, gordura e metabolismo basal e nem melhora da força muscular ipsilateral dos pacientes após 90 dias do ictus (p < 0,05). Conclusão: Não houve redução trófico-metabólica e nem piora funcional estatisticamente significativas no lado corporal ipsilateral ao infarto dos pacientes avaliados. A assistência precoce e contínua da equipe multiprofissional durante os primeiros 90 dias após o ictus conferiu aos pacientes um prognóstico de melhora funcional contralateral significativa, ao avaliar-se mRS, NIHSS, MRC e dinamometria.
Background: The stroke is a severe neurological condition, which affect worldwide people, causing high morbimortality and disability, whose main manifestation is weakness, making rehabilitation crucial. Although common factors may difficulty the successfully rehabilitation, such as sarcopenia, that causes trophic and metabolic impairment in the healthy body side, correlating to the functional damage. This study aims to evaluate trophic, metabolic and functional changes in the impaired body side in patients with ischemic stroke in order to find a correlation between sarcopenia and functional impairment. Patients and methods: We evaluated anthropometric and morphological parameters, performing bioimpedance and dynamometer studies in 21 patients with anterior circulation ischemic stroke in 2 distinct moments: the acute (ultil 48 h after ictus) and chronic phases (90 days after ictus). Results: 21 patients were included (57% men; mean age, 67,09 years; age range, 26 to 84 years). All patients were assisted continually during the study. They did not present ipsilateral muscle mass, protein, water, minerals and fat quantity decrement statistically significant neither enhanced strength 90 days post-stroke (p < 0,05). Conclusion: Patients evalueted did not present reduction statistically significant trophic and metabolic neither functional worse in the ipsilateral body side after unilateral stroke. The early and continuous assistance provided by rehabilitation team during the first 90 days post-ictus improved the functional prognostic in the contralateral side, according to mRS, NIHSS, MRC and dynamometry.
Background: The stroke is a severe neurological condition, which affect worldwide people, causing high morbimortality and disability, whose main manifestation is weakness, making rehabilitation crucial. Although common factors may difficulty the successfully rehabilitation, such as sarcopenia, that causes trophic and metabolic impairment in the healthy body side, correlating to the functional damage. This study aims to evaluate trophic, metabolic and functional changes in the impaired body side in patients with ischemic stroke in order to find a correlation between sarcopenia and functional impairment. Patients and methods: We evaluated anthropometric and morphological parameters, performing bioimpedance and dynamometer studies in 21 patients with anterior circulation ischemic stroke in 2 distinct moments: the acute (ultil 48 h after ictus) and chronic phases (90 days after ictus). Results: 21 patients were included (57% men; mean age, 67,09 years; age range, 26 to 84 years). All patients were assisted continually during the study. They did not present ipsilateral muscle mass, protein, water, minerals and fat quantity decrement statistically significant neither enhanced strength 90 days post-stroke (p < 0,05). Conclusion: Patients evalueted did not present reduction statistically significant trophic and metabolic neither functional worse in the ipsilateral body side after unilateral stroke. The early and continuous assistance provided by rehabilitation team during the first 90 days post-ictus improved the functional prognostic in the contralateral side, according to mRS, NIHSS, MRC and dynamometry.
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Palavras-chave
AVC, Sarcopenia, Reabilitação, Stroke, Rehabilitation