Fatores clínicos associados com o controle de tronco após acidente vascular cerebral: estudo prospectivo
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Data
2020-02-18
Autores
Martins, Laís Geronutti
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Universidade Estadual Paulista (Unesp)
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Introdução: Dentre as doenças cerebrovasculares, o acidente vascular cerebral (AVC) é considerado a segunda causa de morte no Brasil, além de ser a principal causa de disfunção neurológica em adultos. A perda do controle de tronco devido a hemiplegia após o AVC, causa diversas dificuldades e é sabido que o tronco tem papel fundamental no controle do equilíbrio, do controle postural e dos membros durante atividades funcionais e que a musculatura da região abdominal tem uma perda notável de atividade e tônus após o AVC, porém, muitas vezes os programas de reabilitação não dão devida importância a esta alteração e também há escassez na literatura em relação a esse assunto específico. Objetivo: Avaliar a capacidade preditiva dos dados clínicos e funcionais de pacientes pós AVC quanto ao controle motor do tronco. Material e Métodos: Estudo prospectivo, coorte, com pacientes de ambos os sexos, idade maior ou igual a 18 anos, com diagnóstico de AVC isquêmico há no máximo um ano. Os pacientes foram avaliados em relação a cognição através do Mini Exame do Estado Mental, em relação a independência funcional através da Medida de Independência Funcional e do Índice de Barthel em relação ao estado funcional através da Escala de Rankin Modificada e do National Institutes of Health Stroke Scale (NIHSS) e em relação a qualidade de vida através do EuroQol 5-D. Também foram realizados os testes de preensão palmar (Dinamometria de mão), função de tronco (Escala de deficiência de tronco - EDT, equilíbrio e marcha (Escala de mobilidade e equilíbrio de Tinetti). Os dados apresentaram-se em média e desvio padrão e as que não seguiram a normalidade, foram descritos pela mediana e intervalos interqualíticos. Os participantes foram divididos em controle motor de tronco satisfatório e não satisfatório pela mediana da EDT, nas variáveis categóricas foi usado Teste Qui quadrado e as variáveis contínuas foram analisadas pelo teste t ou Mann-Whitney, posteriormente, foi construída uma curva ROC. Resultados: Foram avaliados 37 pacientes com idade média de 62,6 ± 11,8 anos, com NIHSS de alta (p= 0,01) e Rankin de alta (p= 0,00) estatisticamente significantes. Embora as outras análises não tenham sido estatisticamente significantes, pudemos observar que os melhores resultados dos testes e escalas foram obtidos nos pacientes classificados com controle motor de tronco satisfatório. Conclusão: Conclui-se que, a pontuação maior no NIHSS e no Rankin de alta, podem ser considerados preditores para um controle motor de tronco não satisfatório e quanto melhor o controle motor de tronco, melhor a capacidade funcional dos pacientes que tiveram AVC.
Introduction: Among cerebrovascular diseases, Stroke is considered the second cause of death in Brazil, besides being the main cause of neurological dysfunction in adults. The loss of trunk control due to hemiplegia after stroke causes several difficulties. It’s known that the trunk plays a fundamental role in the control of balance, of postural control and limbs during functional activities and that the musculature of the abdominal region has a remarkable loss of activity and tone after stroke. However, this fact is often not given due importance by rehabilitation programs with few scales of evaluation and also specific treatment protocol. Objective: To evaluate the predictive capacity of the clinical and functional data of post-stroke patients regarding trunk motor control. Material and methods: A prospective study, cohort, with patients of both sexes, age greater than or equal to 18 years, with diagnosis of ischemic stroke, in the 1 year period, in the Technical Section of Rehabilitation of the Faculty of Medicine of Botucatu. After signing the Term of Free and Informed Consent, the patients answered questionnaires to assess cognition (Mini-Mental State Examination), functional independence (Modified Rankin Scale National Institutes of Health Stroke Scale (NIHSS)) and quality of life (EuroQol 5-D) and performed palmar grip tests, trunk function (Trunk impairment scale-TIS), balance and gait (Tinetti mobility and balance scale).The data are presented in mean and standard deviation and those that did not follow normal, were by the median and interqualitic intervals. Participants were divided into satisfactory and unsatisfactory trunk motor control by the median of TIS. In the categorical variables Chi-square test was used and continuous variables were analyzed by the t-test or Mann-Whitney test. Results: 37 patients with mean age of 62.6 ± 11.8 years, with high NIHSS (p = 0.01) and high Rankin (p = 0.00). Although the other analyzes were not statistically significant, we observed that the best results of the tests and scales were obtained in patients classified with satisfactory trunk motor control. Conclusion: Conclusion: It is concluded that the higher score in the NIHSS and in the high Rankin, can be considered predictors for an unsatisfactory motor motor control and the better the motor motor control, the better the functional capacity of patients who had a stroke.
Introduction: Among cerebrovascular diseases, Stroke is considered the second cause of death in Brazil, besides being the main cause of neurological dysfunction in adults. The loss of trunk control due to hemiplegia after stroke causes several difficulties. It’s known that the trunk plays a fundamental role in the control of balance, of postural control and limbs during functional activities and that the musculature of the abdominal region has a remarkable loss of activity and tone after stroke. However, this fact is often not given due importance by rehabilitation programs with few scales of evaluation and also specific treatment protocol. Objective: To evaluate the predictive capacity of the clinical and functional data of post-stroke patients regarding trunk motor control. Material and methods: A prospective study, cohort, with patients of both sexes, age greater than or equal to 18 years, with diagnosis of ischemic stroke, in the 1 year period, in the Technical Section of Rehabilitation of the Faculty of Medicine of Botucatu. After signing the Term of Free and Informed Consent, the patients answered questionnaires to assess cognition (Mini-Mental State Examination), functional independence (Modified Rankin Scale National Institutes of Health Stroke Scale (NIHSS)) and quality of life (EuroQol 5-D) and performed palmar grip tests, trunk function (Trunk impairment scale-TIS), balance and gait (Tinetti mobility and balance scale).The data are presented in mean and standard deviation and those that did not follow normal, were by the median and interqualitic intervals. Participants were divided into satisfactory and unsatisfactory trunk motor control by the median of TIS. In the categorical variables Chi-square test was used and continuous variables were analyzed by the t-test or Mann-Whitney test. Results: 37 patients with mean age of 62.6 ± 11.8 years, with high NIHSS (p = 0.01) and high Rankin (p = 0.00). Although the other analyzes were not statistically significant, we observed that the best results of the tests and scales were obtained in patients classified with satisfactory trunk motor control. Conclusion: Conclusion: It is concluded that the higher score in the NIHSS and in the high Rankin, can be considered predictors for an unsatisfactory motor motor control and the better the motor motor control, the better the functional capacity of patients who had a stroke.
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AVC, EDT, Equilíbrio postural, Hemiplegia, Reabilitação, Stroke, Hemiplegia, Rehabilitation