Treino propriocetivo como estratégia de intervenção para melhoria do equilíbrio em indivíduos pós-acidente vascular cerebral: uma revisão sistemática

Autores

  • Ana Fernandes Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa. Lisboa, Portugal.
  • Sofia Rita Fernandes Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal.
  • Beatriz Fernandes Departamento das Ciências da Terapia e Reabilitação, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa. Lisboa, Portugal | H&TRC – Health & Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa. Lisboa, Portugal.

DOI:

https://doi.org/10.25758/set.770

Palavras-chave:

AVC, Acidente vascular cerebral, Equilíbrio, Treino propriocetivo, Controlo postural, Estabilidade postural, Fisioterapia

Resumo

Introdução – As alterações no equilíbrio correspondem a mais de metade das consequências provocadas pelo AVC, por isso, continua a ser de extrema importância investigar qual a melhor estratégia de intervenção nestas alterações de acordo com a atual evidência. Apesar de o treino propriocetivo ser considerado um treino válido em indivíduos pós-AVC, o seu contributo para a melhoria do equilíbrio nestes indivíduos permanece por esclarecer. Objetivo Verificar a eficácia do treino propriocetivo na melhoria do equilíbrio em indivíduos pós-AVC. Métodos Foi efetuada uma revisão sistemática seguindo as recomendações PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). A pesquisa foi realizada nas bases de dados PubMed, PEDro e ScienceDirect, utilizando termos de pesquisa específicos. A Escala PEDro foi utilizada para avaliar a qualidade metodológica dos estudos. Critérios de inclusão: estudos randomizados controlados (RCT) que incluíssem indivíduos com idade igual ou superior a 18 anos, com diagnóstico de AVC e alterações no equilíbrio, cuja intervenção contemplasse treino propriocetivo e a avaliação tivesse medidas objetivas do equilíbrio. Critérios de exclusão: estudos em indivíduos com outras morbilidades neurológicas, com patologia músculo-esquelética nos membros inferiores ou outro tipo de patologias suscetíveis de influenciar o sistema propriocetivo. Resultados A pesquisa identificou um total de 855 estudos, dos quais 14 foram incluídos na revisão após a aplicação dos critérios de elegibilidade. Estes envolveram 677 indivíduos com diagnóstico de AVC crónico (sete estudos) e agudo/subagudo (sete estudos). Os tipos de treino propriocetivo utilizados nos grupos de intervenção (GI) consistiram em: equilíbrio; estimulação somatossensorial com vibração ou estimulação elétrica funcional; reposicionamento articular, combinado com fisioterapia convencional, aplicada também nos grupos de controlo (GC). As medidas de avaliação objetiva do equilíbrio utilizadas consistiram nas escalas de equilíbrio de Berg (BBS) e/ou Tinneti (TBS) e Mini-Balance Evaluation Systems Test (Mini-Best). Houve diferenças estatisticamente significativas (p<0,05) entre GI e GC em 10 dos 14 estudos. Conclusão De acordo com a presente revisão, apesar da heterogeneidade das intervenções (tipo de exercício e duração) e os instrumentos de avaliação usados na análise dos resultados, regista-se uma tendência para a maioria dos estudos incluídos apresentarem resultados positivos nas medidas que avaliam o equilíbrio e o treino propriocetivo.

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Referências

World Health Organization. WHO STEPS stroke manual: the WHO STEPwise approach to stroke surveillance/ Noncommunicable Diseases and Mental Health [homepage]. Geneva: WHO; 2006. Available from: https://iris.who.int/handle/10665/43420

Ferreira RC, Neves RC, Nogueira PJ, Farinha CS, Oliveira AL, Soares A, et al. Portugal – Doenças cérebro-cardiovasculares em números – 2015. Lisboa: Direção-Geral da Saúde; 2016. Available from: https://comum.rcaap.pt/handle/10400.26/15556

Sá MJ. AVC: primeira causa de morte em Portugal. Rev Fac Ciênc Saúde [Internet]. 2009;(6):12-9. Available from: http://hdl.handle.net/10284/1258

Pollock AS, Durward BR, Rowe PJ, Paul JP. What is balance? Clin Rehabil. 2000;14(4):402-6.

Genthon N, Rougier P, Gissot AS, Froger J, Pélissier J, Pérennou D. Contribution of each lower limb to upright standing in stroke patients. Stroke. 2008;39(6):1793-9.

Sawacha Z, Carraro E, Contessa P, Guiotto A, Masiero S, Cobelli C. Relationship between clinical and instrumental balance assessments in chronic post-stroke hemiparesis subjects. J Neuroeng Rehabil. 2013;10:95.

Lendraitienė E, Tamošauskaitė A, Petruševičienė D, Savickas R. Balance evaluation techniques and physical therapy in post-stroke patients: a literature review. Neurol Neurochir Pol. 2017;51(1):92-100.

Apriliyasari RW, Van Truong P, Tsai PS. Effects of proprioceptive training for people with stroke: a meta-analysis of randomized controlled trials. Clin Rehabil. 2022;36(4):431-48.

Rand D. Proprioception deficits in chronic stroke: upper extremity function and daily living. PLoS One. 2018;13(3):e0195043.

Findlater SE, Mazerolle EL, Pike GB, Dukelow SP. Proprioception and motor performance after stroke: an examination of diffusion properties in sensory and motor pathways. Hum Brain Mapp. 2019;40(10):2995-3009.

Ferlinc A, Fabiani E, Velnar T, Gradisnik L. The importance and role of proprioception in the elderly: a short review. Mater Sociomed. 2019;31(3):219-21.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. J Sci Med Sport. 2015;18(3):238-44.

Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther. 2008;88(5):559-66.

Peters S, Ivanova TD, Teasell R, Garland SJ. Is the recovery of functional balance and mobility accompanied by physiological recovery in people with severe impairments after stroke? Neurorehabil Neural Repair. 2014;28(9):847-55.

Garland SJ, Willems DA, Ivanova TD, Miller KJ. Recovery of standing balance and functional mobility after stroke. Arch Phys Med Rehabil. 2003;84(12):1753-9.

Tsang CS, Liao LR, Chung RC, Pang MY. Psychometric properties of the Mini-Balance Evaluation Systems Test (Mini-BESTest) in community-dwelling individuals with chronic stroke. Phys Ther. 2013;93(8):1102-15.

Chinsongkram B, Chaikeeree N, Saengsirisuwan V, Viriyatharakij N, Horak FB, Boonsinsukh R. Reliability and validity of the Balance Evaluation Systems Test (BESTest) in people with subacute stroke. Phys Ther. 2014;94(11):1632-43.

Canbek J, Fulk G, Nof L, Echternach J. Test-retest reliability and construct validity of the tinetti performance-oriented mobility assessment in people with stroke. J Neurol Phys Ther. 2013;37(1):14-9.

Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713-21.

Liao LR, Ng GY, Jones AY, Huang MZ, Pang MY. Whole-body vibration intensities in chronic stroke: a randomized controlled trial. Med Sci Sports Exerc. 2016;48(7):1227-38.

Lee HC, Huang CL, Ho SH, Sung WH. The effect of a virtual reality game intervention on balance for patients with stroke: a randomized controlled trial. Games Health J. 2017;6(5):303-11.

Mansfield A, Aqui A, Danells CJ, Knorr S, Centen A, DePaul VG, et al. Does perturbation-based balance training prevent falls among individuals with chronic stroke? A randomised controlled trial. BMJ Open. 2018;8(8):e021510.

Medina-Rincón A, Bagur-Calafat C, Pérez LM, Barrios-Franquesa AM, Girabent-Farrés M. Development and validation of an exercise programme for recovery balance impairments in poststroke patients. J Stroke Cerebrovasc Dis. 2019;28(11):104314.

Handelzalts S, Kenner-Furman M, Gray G, Soroker N, Shani G, Melzer I. Effects of perturbation-based balance training in subacute persons with stroke: a randomized controlled trial. Neurorehabil Neural Repair. 2019;33(3):213-24.

Hsieh HC. Use of a gaming platform for balance training after a stroke: a randomized trial. Arch Phys Med Rehabil. 2019;100(4):591-7.

Madhuranga PV, Mathangasinghe Y, Anthony DJ. Improving balance with wobble board exercises in stroke patients: single-blind, randomized clinical trial. Top Stroke Rehabil. 2019;26(8):595-601.

Shim J, Hwang S, Ki K, Woo Y. Effects of EMG-triggered FES during trunk pattern in PNF on balance and gait performance in persons with stroke. Restor Neurol Neurosci. 2020;38(2):141-50.

Brunelli S, Gentileschi N, Iosa M, Fusco FR, Grossi V, Duri S, et al. Early balance training with a computerized stabilometric platform in persons with mild hemiparesis in subacute stroke phase: a randomized controlled pilot study. Restor Neurol Neurosci. 2020;38(6):467-75.

Cano-Mañas MJ, Collado-Vázquez S, Rodríguez Hernández J, Muñoz Villena AJ, Cano-de-la-Cuerda R. Effects of video-game based therapy on balance, postural control, functionality, and quality of life of patients with subacute stroke: a randomized controlled trial. J Healthc Eng. 2020;2020:5480315.

Malik AN, Masood T. Task-oriented training and exer-gaming for improving mobility after stroke: a randomized trial. J Pak Med Assoc. 2021;71(1B):186-90.

Marques-Sule E, Arnal-Gómez A, Buitrago-Jiménez G, Suso-Martí L, Cuenca-Martínez F, Espí-López GV. Effectiveness of Nintendo Wii and physical therapy in functionality, balance, and daily activities in chronic stroke patients. J Am Med Dir Assoc. 2021;22(5):1073-80.

Önal B, Sertel M, Karaca G. Effect of plantar vibration on static and dynamic balance in stroke patients: a randomised controlled study. Physiotherapy. 2022;116:1-8.

Wei N, Cai M. Optimal frequency of whole body vibration training for improving balance and physical performance in the older people with chronic stroke: a randomized controlled trial. Clin Rehabil. 2022;36(3):342-9.

Pintado-Izquierdo S, Cano-de-la-Cuerda R, Ortiz-Gutiérrez RM. Video game-based therapy on balance and gait of patients with stroke: a systematic review. Appl Sci. 2020;10(18):6426.

Kim EK, Kang JH, Park JS, Jung BH. Clinical feasibility of interactive commercial Nintendo gaming for chronic stroke rehabilitation. J Phys Ther Sci. 2012;24(9):901-3.

Li Z, Han XG, Sheng J, Ma SJ. Virtual reality for improving balance in patients after stroke: a systematic review and meta-analysis. Clin Rehabil. 2016;30(5):432-40.

Lubetzky-Vilnai A, Kartin D. The effect of balance training on balance performance in individuals poststroke: a systematic review. J Neurol Phys Ther. 2010;34(3):127-37.

Lu J, Xu G, Wang Y. Effects of whole body vibration training on people with chronic stroke: a systematic review and meta-analysis. Top Stroke Rehabil. 2015;22(3):161-8.

Yin Y, Wang J, Yu Z, Zhou L, Liu X, Cai H, et al. Does whole-body vibration training have a positive effect on balance and walking function in patients with stroke? A meta-analysis. Front Hum Neurosci. 2023;16:1076665.

Khalifeloo M, Naghdi S, Ansari NN, Akbari M, Jalaie S, Jannat D, et al. A study on the immediate effects of plantar vibration on balance dysfunction in patients with stroke. J Exerc Rehabil. 2018;14(2):259-66.

Pereira S, Mehta S, McIntyre A, Lobo L, Teasell RW. Functional electrical stimulation for improving gait in persons with chronic stroke. Top Stroke Rehabil. 2012;19(6):491-8.

Howlett OA, Lannin NA, Ada L, McKinstry C. Functional electrical stimulation improves activity after stroke: a systematic review with meta-analysis. Arch Phys Med Rehabil. 2015;96(5):934-43.

Alayat MS, Almatrafi NA, El Fiky AA, Elsodany AM, Shousha TM, Basuodan R. The effectiveness of perturbation-based training in the treatment of patients with stroke: a systematic review and meta-analysis. Neurosci Insights. 2022;17:26331055221114818.

Winter L, Huang Q, Sertic JV, Konczak J. The effectiveness of proprioceptive training for improving motor performance and motor dysfunction: a systematic review. Front Rehabil Sci. 2022;3:830166.

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30-12-2024

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Treino propriocetivo como estratégia de intervenção para melhoria do equilíbrio em indivíduos pós-acidente vascular cerebral: uma revisão sistemática. (2024). Saúde & Tecnologia, 30, e770. https://doi.org/10.25758/set.770