Avaliação eletromiográfica dos músculos do membro superior de indivíduos hemiparéticos com uso da terapia do espelho
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Data
2016-05-06
Autores
Rodrigues, Ana Cláudia Tavares [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O Acidente Vascular Encefálico (AVE) vem sofrendo um aumento considerável em sua incidência mundial ao longo dos anos. Dentre os comprometimentos causados pelo AVE, a hemiparesia no lado contralateral da lesão é um dos mais ocorrentes, gerando um impacto funcional nos pacientes, comprometendo sua qualidade de vida. Na tentativa de minimizar os déficits sensoriomotores e acelerar o processo de recuperação funcional, terapeutas ocupacionais e fisioterapeutas têm utilizado uma nova técnica na reabilitação do membro superior destes pacientes: a Terapia do Espelho. O objetivo deste estudo foi analisar a atividade elétrica muscular durante a realização da Terapia do Espelho no membro superior parético de indivíduos com sequela de AVE. Participaram desta pesquisa dez usuários do Centro de Reabilitação SORRI-BAURU, com histórico de AVE há pelo menos seis meses, com sequela de hemiparesia. A coleta de dados foi constituída pela aplicação dos instrumentos utilizados como critérios de elegibilidade, preenchimento de uma anamnese, aplicação da Escala Modificada de Ashworth e realização da avaliação eletromiográfica do membro superior acometido nos seguintes músculos: abdutor curto do polegar, flexor radial do carpo, extensor ulnar do carpo, bíceps e tríceps braquial. A eletromiografia foi coletada durante a realização de cinco tipos de exercícios ativos em quatro situações aleatórias: realizando os movimentos propostos somente com o lado preservado; realizando os movimentos com ambos os membros ao mesmo tempo; utilizando o espelho apoiado sagitalmente, realizando os movimentos somente com o lado não afetado e, ainda, utilizando o espelho, realizando os exercícios com ambos os membros superiores; além disso, foi coletada a atividade muscular durante o repouso a fim de comparação. A análise do sinal EMG foi realizada em rotinas específicas desenvolvidas em ambiente Matlab (Mathworks®) e a análise estatística foi aplicada utilizando o software SPSS® e o teste ANOVA para medidas repetidas, sendo adotado o nível de significância de p<0,05. Foram encontradas diferenças significativas nos dados referentes aos músculos abdutor curto do polegar (p=0,005); flexor radial do carpo (p=0,032); bíceps braquial (p=0,002) e tríceps braquial (p=0,024), provavelmente, devido à uma adequação do tônus durante a realização da Terapia do Espelho, porém, ainda é necessária a realização de estudos que comparem estes dados pré e pós-intervenção com o uso da técnica, em busca de uma recuperação motora mais efetiva do membro acometido.
The Stroke has undergone a considerable increase in their incidence worldwide over the years. Among the impairments caused by stroke, hemiparesis on the contralateral side of the injury is one of the most occurring, generating a functional impact on patients, compromising their quality of life. In an attempt to minimize the sensorimotor deficits and accelerate the functional recovery process, occupational therapists and physical therapists have used a new technique in the upper limb rehabilitation of these patients: the Mirror Therapy. The aim of this study was to analyze muscle electrical activity during the performance of the Mirror Therapy with the upper limb of paretic subjects with stroke. Participated in this survey ten users of the SORRI-BAURU Rehabilitation Center, with stroke history for at least six months with hemiparesis sequel. Data collection was formed by the application of the instruments used as eligibility criteria, completing a medical history, application of the Modified Ashworth Scale and realization of electromyographic evaluation of the affected upper limb in the following muscles: abductor pollicis brevis, flexor carpi radialis, extensor carpi ulnaris, biceps and triceps. Electromyography was collected during the course of five types of active exercises in four random situations: performing the proposed movements only with preserved side; performing movements with both members at the same time; using the sagittal mirror supported, performing movements only with the unaffected side and also using the mirror, performing exercises with both upper limbs; furthermore, it was collected muscular activity during rest in order for comparison. The analysis of the EMG signal was performed in specific routines developed in Matlab (Mathworks®) and statistical analysis was applied using SPSS® software and ANOVA for repeated measures, adopting the significance level of p<0.05. Significant differences were found on the data for abductor pollicis brevis (p = 0.005); flexor carpi radialis (p = 0.032); biceps (p = 0.002) and triceps (p = 0.024), probably due to an adjustment of tone during the course of mirror therapy, however, it is still necessary to carry out studies comparing these data before and after the intervention using the technique in search of a more effective motor recovery member affected.
The Stroke has undergone a considerable increase in their incidence worldwide over the years. Among the impairments caused by stroke, hemiparesis on the contralateral side of the injury is one of the most occurring, generating a functional impact on patients, compromising their quality of life. In an attempt to minimize the sensorimotor deficits and accelerate the functional recovery process, occupational therapists and physical therapists have used a new technique in the upper limb rehabilitation of these patients: the Mirror Therapy. The aim of this study was to analyze muscle electrical activity during the performance of the Mirror Therapy with the upper limb of paretic subjects with stroke. Participated in this survey ten users of the SORRI-BAURU Rehabilitation Center, with stroke history for at least six months with hemiparesis sequel. Data collection was formed by the application of the instruments used as eligibility criteria, completing a medical history, application of the Modified Ashworth Scale and realization of electromyographic evaluation of the affected upper limb in the following muscles: abductor pollicis brevis, flexor carpi radialis, extensor carpi ulnaris, biceps and triceps. Electromyography was collected during the course of five types of active exercises in four random situations: performing the proposed movements only with preserved side; performing movements with both members at the same time; using the sagittal mirror supported, performing movements only with the unaffected side and also using the mirror, performing exercises with both upper limbs; furthermore, it was collected muscular activity during rest in order for comparison. The analysis of the EMG signal was performed in specific routines developed in Matlab (Mathworks®) and statistical analysis was applied using SPSS® software and ANOVA for repeated measures, adopting the significance level of p<0.05. Significant differences were found on the data for abductor pollicis brevis (p = 0.005); flexor carpi radialis (p = 0.032); biceps (p = 0.002) and triceps (p = 0.024), probably due to an adjustment of tone during the course of mirror therapy, however, it is still necessary to carry out studies comparing these data before and after the intervention using the technique in search of a more effective motor recovery member affected.
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Palavras-chave
Acidente Vascular Encefálico, Eletromiografia, Terapia Ocupacional, Stroke, Electromyography, Occupational Therapy