Modelos de intervenção em fisioterapia nos pacientes com espasticidade pós AVC: revisão da literatura

Mestrado em FisioterapiaAcidente vascular cerebral (AVC) é uma doença de causa súbita que afeta qualquer zona no cérebro provocando perda da função contra lateral relativamente à área encefálica afetada. Um dos sintomas do AVC mais frequente e responsável pela incapacidade funcional é a espasticidade. A espasticidade caracteriza-se pelo aumento de excitabilidade dos reflexos de estiramento e exacerbação dos reflexos tendinosos, sendo dependente da velocidade, provocando resistência aos movimentos passivos nos músculos afetados em repouso. Objetivo: Analisar os modelos utilizados em fisioterapia na redução da espasticidade com base na evidência científica. Método: Realizou-se uma revisão da bibliografia, nas bases de dados PEDro, SciELO, B-on e MEDLINE, artigos relacionados a intervenção da fisioterapia na redução da espasticidade após AVC, no período decorrente de 2007 a 2015, ambos sexos, com idade igual ou superior a 18 anos, escritos na língua portuguesa e inglesa, sendo selecionados 331 artigos, após aplicação dos critérios de inclusão e exclusão tais como: estudos realizados em população não humana, em diferentes patologias que não o AVC, artigos onde apenas o resumo estava disponível, bem como ensaios que não contemplassem uma medida objetiva para avaliação da espasticidade, não aplicassem nenhuma intervenção para a espasticidade e/ou submetidos a cirurgia. Desta forma foram incluídos, no final, 71 artigos para análise criteriosa. Resultado: A informação dos 71 artigos analizados foi organizada do seguinte modo: nome do(s) autor (es), ano de publicação, tipo de estudo, tamanho da amostra, instrumentos de avaliação utilizados, procedimento ou programa de intervenção implementado, resultados e conclusões. Deste modo verificou-se varios modelos de intervenção em fisioterapia que são eficazes na redução da espasticidade, alguns destes resultados são a curto prazo ou seja 4 a 6 meses após a intervenção de fisioterapia. Discussão: Os vários estudos demosntraram que as técnicas utilizadas em fisioterapia de forma isolada apresentam diminuição da espasticidade, contudo aqueles que utilizaram terapias combinadas tem melhores resultados do que as terapias individuais. As técnicas mais utlizadas nos estudos foram: estimulação elétrica funcional, estimulação elétrica neuromuscular, estimulação nervosa elétrica transcutanea, intervenção segundo o modelo Bobath, facilitação neuromuscular proprioceptiva, terapia do movimento induzido por contenção (CIMT) ou técnica restritiva, mirror therapy, fisioterapia convencional, terapia por vibração e Intervenção utilizando tarefas orientadas. Conclusão: Intervenção da fisioterapia reduz a espasticidade, melhora a funcionalidade e as atividades de vida diária, devendo ser aplicada de forma prococe, não apresentando efeitos secundários. É fundamental aconselhar os pacientes a fazer fisioterapia por muito tempo e/ou ser orientados a realizar tarefas direcionadas para a atividades de vida diária em casa.ABSTRACT - Cerebral vascular accident (CVA) is a sudden cause disease that affects any área in the brain causing loss of function on the side corresponding to the affected área. Spasticity is characterized by the increase of excitability of stretch reflexes and exacerbation of tendon reflexes, dependent on speed and endurance of passive movements in the affected muscles at rest. Objective: Reviews of intervention models in physical therapy are more effective in reducing spasticity in post-stroke patients. Method: We performed a review of bibliography, on databases such as, PEDro, SciELO, MEDLINE, and B-on, of articles related to physiotherapy intervention in patients with stroke in which have spasticity, between 2007 to 2015 both sexes, less than 18 years of age, written in English and Portuguese language, 331 articles were selected after acquisition of items the selection process occurred in several steps since the deletion after reading the summaries, the duplicate articles, animal studies and abstracts of articles, surgical intervention and other pathologies, 71 articles were included for careful analysis. Results: The information of 71 articles analyzed was organized as follows: name of the author (s), year of publication, type of study, sample size, assessment instruments used, procedure or intervention program implemented, results and conclusions. Thus it was found several models of intervention in physical therapy that are effective in reducing spasticity, some of these are short-term results that is 4 to 6 months after the intervention of physiotherapy. Discussion: Several studies demonstrated that the techniques used in physical therapy in isolation presented decreased spasticity, however, those who used combined therapies has better results than individual therapies. The most used techniques in the studies were: functional electrical stimulation, neuromuscular electrical stimulation, electrical neural stimulation transcutaneous, Bobath model intervention, proprioceptive neuromuscular facilitation, contention-induced movement therapy (CIMT) or restrictive technique, mirror therapy, physical therapy, and speech therapy using targeted tasks. Conclusion: Physiotherapy intervention reduces the spasticity, improves the functionality and the activities of daily life, and should be applied in such a way precocious, not showing side effects. It is essential to advise patients to do physical therapy for a long time and/or be instructed to perform tasks directed to the activities of daily life at home.N/

Accessibility of Health Data Representations for Older Adults: Challenges and Opportunities for Design

Health data of consumer off-the-shelf wearable devices is often conveyed to users through visual data representations and analyses. However, this is not always accessible to people with disabilities or older people due to low vision, cognitive impairments or literacy issues. Due to trade-offs between aesthetics predominance or information overload, real-time user feedback may not be conveyed easily from sensor devices through visual cues like graphs and texts. These difficulties may hinder critical data understanding. Additional auditory and tactile feedback can also provide immediate and accessible cues from these wearable devices, but it is necessary to understand existing data representation limitations initially. To avoid higher cognitive and visual overload, auditory and haptic cues can be designed to complement, replace or reinforce visual cues. In this paper, we outline the challenges in existing data representation and the necessary evidence to enhance the accessibility of health information from personal sensing devices used to monitor health parameters such as blood pressure, sleep, activity, heart rate and more. By creating innovative and inclusive user feedback, users will likely want to engage and interact with new devices and their own data

Cerebral Palsy

Nowadays, cerebral palsy (CP) rehabilitation, along with medical and surgical interventions in children with CP, leads to better motor and postural control and can ensure ambulation and functional independence. In achieving these improvements, many modern practices may be used, such as comprehensive multidisciplinary assessment, clinical decision making, multilevel surgery, botulinum toxin applications, robotic ambulation applications, treadmill, and other walking aids to increase the quality and endurance of walking. Trainings are based on neurodevelopmental therapy, muscle training and strength applications, adaptive equipment and orthotics, communication, technological solves, and many others beyond the scope of this book. In the years of clinical and academic experiences, children with cerebral palsy have shown us that the world needs a book to give clinical knowledge to health professionals regarding these important issue. This book is an attempt to fulfill and to give “current steps” about CP. The book is intended for use by physicians, therapists, and allied health professionals who treat/rehabilitate children with CP. We focus on the recent concepts in the treatment of body and structure problems and describe the associated disability, providing suggestions for further reading. All authors presented the most frequently used and accepted treatment methods with scientifically proven efficacy and included references at the end of each chapter

Proceedings of the 10th international conference on disability, virtual reality and associated technologies (ICDVRAT 2014)

The proceedings of the conferenc