| Author(s): |
Roberta de Oliveira
Total Authors: 1
|
| Document type: | Doctoral Thesis |
| Press: | Campinas, SP. , ilustrações. |
| Institution: | Universidade Estadual de Campinas (UNICAMP). Faculdade de Ciências Médicas |
| Defense date: | 2008-10-24 |
| Examining board members: |
Antonio Guilherme Borges Neto;
Frederico Tadeu Deloroso;
Ricardo Ramina;
Anamarli Nucci;
Yvens Barbosa Fernandes
|
| Advisor: | Antonio Guilherme Borges Neto |
| Field of knowledge: | Health Sciences - Physiotherapy and Occupational Therapy |
| Indexed in: | Base Acervus-UNICAMP; Biblioteca Digital da UNICAMP |
| Location: | Universidade Estadual de Campinas. Biblioteca Central Cesar Lattes; T/UNICAMP; OL4a; Universidade Estadual de Campinas. Biblioteca da Faculdade de Ciências Médicas; T/UNICAMP; OL4a |
| Abstract | |
Stroke is recognized as one of the major causes of morbidity and mortality. Sequels deriving from this event may lead to motor disability and from mild to severe deficits. In order to better classify sensory-motor dysfunction, balance and ability to perform activities of daily living (ADL), quantitative and qualitative evaluation scales have been used. The aim of Article 1 was to verify the correlation between the Fugl-Meyer Assessment Scale (FM), Berg Balance Scale (BBS) and Barthel Index (BI). Twenty chronic stroke patients were submitted to an evaluation that spent approximately one hour. The results demonstrated that the FM was positively correlated with the BBS and BI, showing that when they are employed together, make it possible to design the general clinical performance of the stroke patient. After stroke, upper limb function impairment is the most common sequel that could lead to permanent dysfunction. Reaching movements made with hemiparetic upper limbs are often followed by compensatory trunk and shoulder-girdle movements. The use of the trunk restraint therapy aims at avoiding the compensatory trunk movement providing the development of normal motor patterns in the affected upper limb. The benefits of the trunk restraint therapy could be observed through the clinical measures scales in eleven stroke subjects that performed twenty training sessions (Article 2). In another study (Article 3), twenty patients were recruited and divided into two training groups (20 sessions): Trunk restraint group (TRG - reaching training with trunk restraint) and trunk free group (TFG - reaching training without trunk restraint, providing emphasis in the verbal cue). The aim was to verify the long term benefits of the task-specific training with trunk restraint using the clinical scales (Modified Ashworth Scale, FM, BI and BBS) and the kinematic analysis (displacement, velocity, angles) like evaluation tools. The evaluations were performed in three phases: the first, in admission time (PRE test); the second, after the end of the treatment (POST test); and the third, three months after the completed treatment (retention test - RET test). Task-specific training associated with the trunk restraint therapy (TRG) proved to be a long-term effective treatment in the enhancement of shoulder and elbow active joint range, as well as in the improvement of the internal planning of the movement. However, the continuous use of restraint may have caused dependence to the patients and was not efficient in long term reduction of the additional degrees of freedom (trunk). Although the verbal cue training (TFG) was more effective in the trunk retention, there was no significant improvement in the upper limb joint ranges. Therefore patients who sustained this type of treatment developed more attention in the abnormal recruitment of the additional degrees of freedom, and did not efficiently explore the multi-joint combinations presented in the upper limb. (AU) | |