Effects of a somatosensory rehabilitation program in patients with chronic hemiparesis

Orientador: Antônio Guilherme Borges NetoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: O déficit somatossensorial está entre os resultados mais frequentes das lesões cerebrais, em especial após o acidente vascular cerebral (AVC), a alteração se torna importante, pois danifica a exploração eficaz do ambiente e o desempenho de tarefas diárias, afetando adversamente a qualidade de vida, a segurança pessoal, e a recuperação motora. Instrumentos de medida quantitativos e qualitativos capazes de projetar o perfil neurológico dos pacientes pós-AVC são amplamente utilizados e auxiliam os profissionais de saúde a avaliarem o nível de comprometimento das funções sensório-motoras e capacidades funcionais, quando estas são empregadas em conjunto garantem a projeção elucidativa do desempenho geral do paciente. O objetivo do Artigo 1 foi descrever a função somatossensorial do membro superior afetado de hemiparéticos crônicos pós-AVC e verificar as correlações entre instrumentos de medida das funções motora e sensorial, realizadas com e sem privação visual. Foram aplicadas as seguintes avaliações: Protocolo de Desempenho Físico de Fugl-Meyer (FM), Avaliação Sensorial de Nottingham (ASN), e os testes de: Manipulação de Papel (MP), Sequência Motora (SM), Alcance e Preensão (AP), Testes Funcionais (TF), Discriminação Tátil (DT), Discriminação de Peso (DP) e Reconhecimento Tátil de Objetos (RO) em 20 pacientes. Os resultados apontaram correlações moderadas entre a FM motora e itens da subescala sensação tátil da ASN (pressão, temperatura, toque bilateral e propriocepção); a FM sensibilidade correlacionou-se a ASN total; e o teste DP se correlacionou com itens da ANS (pressão, picada e localização tátil). Além disso, durante os testes realizados com privação visual os pacientes demonstraram pior desempenho, fortalecendo o fato de que pacientes pós- AVC se tornam mais dependentes de informações visuais para compensar a perda sensório-motora. O objetivo do Artigo 2 foi avaliar os efeitos de um programa de reabilitação somatossensorial em paciente hemiparéticos crônicos pós-AVC e propor metas para a reabilitação sensorial. Foram recrutados 20 pacientes que foram avaliados por duas escalas, sete testes específicos, e um teste diagnóstico. Todos os pacientes realizaram uma avaliação Inicial (aplicação dos instrumentos de medida); Tratamento Convencional (sem estímulo sensorial) segunda avaliação; Tratamento Específico (com estímulo sensorial); terceira avaliação; período de follow-up e; quarta avaliação. A intervenção consistiu no estímulo sensorial contínuo de objetos com texturas e com características superficiais diferentes; no treinamento de propriocepção para o membro superior afetado; e no treinamento de reconhecimento de objetos. Durante cada sessão, houve o treinamento dessas três atividades sensoriais. Os efeitos da intervenção com o tratamento específico através da exposição de estímulos sensoriais apresentou resultados expressivos da melhora da função sensorial nas duas escalas funcionais, em quatro dos sete testes realizados de olhos fechados, e em um dos quatro testes realizados de olhos abertos quando comparados ao do treinamento convencional. A proposta da reabilitação inclui o fato de que a apresentação de repetidos estímulos sensoriais maximiza o uso da função sensorial residual e se aproveita da recuperação sensória. Os programas de treinamento que incluem exercícios de estimulação com diferentes modalidades somatossensoriais podem ser mais adequados para a reabilitação do déficit somatosensorial e, além disso, podem proporcionar ganhos na função motora. A abordagem visa melhorar habilidades perdidas ao invés de focar sobre a compensaçãoAbstract: Somatosensory deficit is among the most frequent outcome of brain injury, especially after the stroke, the change becomes important because it damages the effective exploitation of the environment and the performance of daily tasks, adversely affecting the quality of life, personal safety, and motor recovery. Instruments for measuring quantitative and qualitative able to design the neurological profile of patients with stroke are widely used and help health professionals to assess the level of impairment of sensorimotor functions and functional abilities, when they are used together ensure the projection illuminating the of the patient performance. The aim of Article 1 was describe the somatosensory function of the affected upper limb of hemiparetic stroke patients and investigate the correlations between measurements of motor and sensory functions in tasks with and without visual deprivation. We applied the Fugl-Meyer Assessment (FMA), Nottingham Sensory Assessment (NSA), and motor and sensory tests: Paper manipulation (PM), Motor Sequences (MS), Reaching and Grasping (RG) Functional Tests (TF), Tactile Discrimination (TD), Weight Discrimination (WD) and Tactile Recognition of Objects (RO) in 20 patients. The results indicated moderate correlations between the FMA motor subscale and the tactile sensation score of the NSA. Additionally, the FMA sensitivity was correlated with the NSA total; and performance on the WD test items correlated with the NSA. Moreover, during the tests with visual deprivation patients demonstrated lower performance, reinforcing the fact that individuals who suffered from a stroke become more dependent on visual information to compensate for the loss sensory-motor. The aim of Article 2 was to evaluate the effects of a sensorimotor rehabilitation program for upper limb stroke in patients with chronic and somatosensory deficit and propose targets for sensory rehabilitation. We recruited 20 patients who were evaluated by two scales, seven specific tests, and a diagnostic test. All participants underwent an Initial Evaluation (application of measuring instruments); Conventional Treatment (without sensory stimulation); Second Assessment; Specific Treatment (with sensory stimulation); Third Evaluation; Follow-up period and, Fourth Assessment. The intervention consisted of continuous sensory stimulation with textures and objects that had different surface characteristics, proprioception training for the affected upper limb, and object recognition. Each session consisted of these three activities. The effects of intervention with specific treatment by exposing sensory stimulus showed significant improvement in sensory function in the two functional scales in four of the seven tests performed with eyes closed, and one of the four tests performed with eyes open compared to conventional training. The proposal includes rehabilitation of the fact that the repeated presentation of sensory stimuli maximizes the use of residual sensory function and takes advantage of sensory recovery. The training programs that include exercises with different modalities somatosensory stimulation may be more appropriate for the rehabilitation of somatosensory deficits and, in addition, can provide gains in motor function. The approach aims to improve lost abilities rather than focusing on compensationDoutoradoCiencias BiomedicasDoutora em Ciências Médica

Correlations between motor and sensory functions in upper limb chronic hemiparetics after stroke

OBJECTIVE: Describe the somatosensory function of the affected upper limb of hemiparetic stroke patients and investigate the correlations between measurements of motor and sensory functions in tasks with and without visual deprivation. METHOD: We applied the Fugl-Meyer Assessment (FMA), Nottingham Sensory Assessment (NSA), and several motor and sensory tests: Paper manipulation (PM), Motor Sequences (MS), Reaching and grasping (RG) Tests Functional (TF), Tactile Discrimination (TD), Weight Discrimination (WD) and Tactile Recognition of Objects (RO). RESULTS: We found moderate correlations between the FMA motor subscale and the tactile sensation score of the NSA. Additionally, the FMA sensitivity was correlated with the NSA total; and performance on the WD test items correlated with the NSA. CONCLUSION: There was a correlation between the sensory and motor functions of the upper limb in chronic hemiparetic stroke patients. Additionally, there was a greater reliance on visual information to compensate for lost sensory-motor skills

Sensory Deficits In Ipsilesional Upper-extremity In Chronic Stroke Patients.

Objective To investigate somatosensory deficits in the ipsilesional wrist and hand in chronic stroke patients and correlate these deficits with contralesional sensorimotor dysfunctions, functional testing, laterality and handedness.Methods Fifty subjects (twenty-two healthy volunteers and twenty-eight stroke patients) underwent evaluation with Semmes-Weinstein monofilaments, the sensory and motor Fugl-Meyer Assessment, the Nottingham Sensory Assessment in both wrists and hands and functional tests.Results Twenty-five patients had sensory changes in the wrist and hand contralateral to the stroke, and eighteen patients (64%) had sensory deficits in the ipsilesional wrist and hand. The most significant ipsilesional sensory loss was observed in the left-handed patients. We found that the patients with brain damage in the right hemisphere had better scores for ipsilesional tactile sensation.Conclusions A reduction in ipsilesional conscious proprioception, tactile or thermal sensation was found in stroke subjects. Right hemisphere damage and right-handed subjects had better scores in ipsilesional tactile sensation.73834-83