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Estabilometric and functional magnetic resonance imaging correlates between two protocols of forced use therapy in rehabilitation of the lower limb of patients with chronic hemiparesis post-stroke

Grant number: 11/10017-2
Support Opportunities:Scholarships in Brazil - Doctorate
Effective date (Start): March 01, 2012
Effective date (End): October 31, 2014
Field of knowledge:Health Sciences - Physiotherapy and Occupational Therapy
Principal Investigator:João Eduardo de Araujo
Grantee:Amanda Cunha Fuzaro
Host Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil


Stroke is the second condition in number of deaths in worldwide and the leading cause of dependence in adults in the long run, being the major generator of physical and cognitive disabilities. Over 80% of survivors have some paralysis, most often in the upper limb (UL). Another striking feature of this pathology is the presence of paresis in the lower limb (LL). The hemiparetic gait of an individual requires about 55 to 110% higher energy expenditure compared to healthy subjects. The center of gravity in hemiparetic patients are diverted to non-paretic side, and was influenced by the decrease in weight distribution on the paretic side. There are elements in the literature supporting the fact that the activity shape the behavior engine. Specifically for UL, have been used to constraint-induced movement therapy (CIMT) and forced use therapy (FUT). Previous work in our laboratory showed that both techniques are able to promote gains in balance and gait, proving that only the use of restricting the paretic limb was sufficient to produce such gains, however, questions remain, since these works were supported by functional scales and therefore could not determine specific gain. Because still has a large gap in the knowledge of lower limb rehabilitation through FUT, this paper aims to advance this knowledge. The objectives are to evaluate the benefits of TUF in the rehabilitation of lower limbs. For that, Quantify by stabilometry test (force platform) and the analysis of surface electromyography gains in balance and gait. Also, check through the examination of functional magnetic resonance imaging, if there are changes in cortical maps induced by therapy and maybe justify these gains. Beyond we will use different periods of constriction and advance knowledge in relation to the daily time of constriction. To do that, would be recruited 36 subjects who suffered ischemic stroke and exhibiting motor hemiparesis as a sequela. They will be randomized into three groups, and TUF12 and TUF24 to be treated with the therapy in question for 12 and 24 hours respectively, and a control group that receives conventional physiotherapy treatment. Performance tests are conducted before the start of treatment (Initial), with 2 weeks of intervention (Intermediate), at the end (Final) and 3 months after the treatment (follow-up). The assessment instruments will be the National Institute of Health Stroke Scale as adimissional scale, examination of functional magnetic resonance imaging. These instruments will not be applied in the interim assessment. Other instruments used are the force platform, surface electromyography, testing of 10 meters and 6 minutes and Berg Balance Scale. The resonance will only be applied in groups and TUF1 TUF2, before beginning treatment and after the treatment, with positive response to this last test, it will be repeated after three months in order to check the maintenance of cortical change. (AU)

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Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
NAKADA, CAROLINA S.; MENINGRONI, PAULA C.; SILVA FERREIRA, ANA CLAUDIA; HATA, LUCIANA; FUZARO, AMANDA C.; MARQUES JUNIOR, WILSON; DE ARAUJO, JOAO EDUARDO. Ipsilateral proprioceptive neuromuscular facilitation patterns improve overflow and reduce foot drop in patients with demyelinating polyneuropathy. JOURNAL OF EXERCISE REHABILITATION, v. 14, n. 3, p. 503-508, . (07/03285-5, 07/05803-3, 11/10017-2)

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