Efeitos da Terapia do Espelho na função motora do membro superior parético pós-AVC crônico
DOI:
https://doi.org/10.34024/rnc.2025.v33.19627Palavras-chave:
Terapia do Espelho, Acidente Vascular Cerebral, função motora, membro superior, aprendizagem motoraResumo
Introdução. Acidente vascular cerebral (AVC) corresponde a uma das principais causas de incapacidade e a plegia/paresia do membro superior (MS) é tida como a mais significativa. Objetivo. Avaliar os efeitos da Terapia do Espelho (TE) na função motora do MS parético de indivíduos acometidos por acidente vascular cerebral em fase crônica. Método. Estudo experimental de abordagem quantitativa aprovado pelo Comitê de Ética em Pesquisa (CAAE:58481922.6.0000.5116). A amostra foi composta por 10 indivíduos hemiparéticos com AVC unilateral, submetidos a avaliação da espasticidade pela Escala de Ashworth e da função motora do MS pela Escala Fugl-Meyer (EFM). O protocolo de intervenção consistiu em 12 sessões de TE com duração de 50 minutos e frequência de 4 vezes na semana, durante três semanas. Resultados. A amostra apresentou média de idade de 46,20 anos e a maior parte (60%) relatou tempo de lesão entre 1 e 3 anos. Após a TE foi possível identificar aumento significante das funções motoras nas seguintes dimensões: movimentação passiva (p=0,0138), sinergia flexora (p=0,0107), movimentos com e sem sinergia (P=0,0414), função da mão (p=0,0149) e escore geral EFM (p=0,0057). Não houve melhora na espasticidade. Conclusão. Os efeitos da TE mostraram-se benéficos na melhora na função motora dos pacientes acometidos por acidente vascular cerebral em fase crônica.
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Referências
Lucianelli D Junior, Melo IS Junior, Holanda AR, Alencar JP, Rodrigues LJ, Valentin FN. A informação é a principal ferramenta para diminuir a grande incidência de Acidente Vascular Cerebral - AVC e seus agravos na população. Braz J Health R 2022;5:88-94. https://doi.org/10.34119/bjhrv5n1-009
Siqueira S, Schneiders PB, Silva ALG. Intervenções fisioterapêuticas e sua efetividade na reabilitação do paciente acometido por acidente vascular cerebral. Fisioter Bras 2019;20:560-9. https://doi.org/10.33233/fb.v20i4.2542
Zhao Y, Zhang M, Zhang Y, Li M, Wang Y, Zhou L, et al. Neuronal injuries in cerebral infarction and ischemic stroke: from mechanisms to treatment. Int J Mol Med 2022;49:1-9. https://doi.org/10.3892/ijmm.2021.5070
Potter TBH, Tannous J, Vahidy FS. A contemporary review of epidemiology, risk factors, etiology, and outcomes of premature stroke. Curr Atheroscler Rep 2022;24:939-48. https://doi.org/10.1007/s11883-022-01067-x
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation 2020;141:e139-596. https://doi.org/10.1161/CIR.0000000000000757
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1211-59. https://doi.org/10.1016/s0140-6736(17)32154-2
Ferezin SM, Castro BM, Ferreira AA. Epidemiologia do Ataque Isquêmico Transitório no Brasil. Braz J Develop 2020;6:61125-36. https://doi.org/10.34117/bjdv6n8-506
Wu J, Zeng A, Chen Z, Wei Y, Huang K, Chen J, et al. Effects of virtual reality training on upper limb function and balance in stroke patients: systematic review and meta-meta-analysis. J Med Internet Res 2021;23:e31051. https://doi.org/10.2196%2F31051
Thieme H, Morkisch N, Merholz J, Pohl M, Behrens J, Borgetto B, et al. Mirror therapy for improving motor function after stroke. Cochr Data Syst R 2018;2018:1-156. https://doi.org/10.1002/14651858.CD008449.pub3
Hatem SM, Saussez G, Della Faille M, Prist V, Zhang X, Dispa D, et al. Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery. Front Hum Neurosci 2016;10:442. https://doi.org/10.3389/fnhum.2016.00442
Lee, DH, Lee, JH. A study on the physical therapy approach for improving the upper extremity function of spastic ischemic stroke patients. Int J Adv Nurs Educ Res 2019;4:7-12. https://doi.org/10.21742/ijaner.2019.4.3.02
Nogueira NGHM, Parma JO, Leão SESA, Sales IS, Macedo LC, Galvão ACDR, et al. Mirror therapy in upper limb motor recovery and activities of daily living, and its neural correlates in stroke individuals: a systematic review and meta-analysis. Brain Res Bull 2021;177:217-38.https://doi.org/10.1016/j.brainresbull.2021.10.003
Jonsdottir J, Thorsen R, Aprile I, Galeri S, Spannocchi G, Beghi E, et al. Arm rehabilitation in post stroke subjects: A randomized controlled trial on the efficacy of myoelectrically driven FES applied in a task-oriented approach. Plos One 2017;12:e0188642. https://doi.org/10.1371/journal.pone.0188642
Huang J, Ji JR, Liang C, Zhang YZ, Sun HC, Yan YH, et al. Effects of physical therapy-based rehabilitation on recovery of upper limb motor function after stroke in adults: a systematic review and meta-analysis of randomized controlled trials. Ann Palliat Med 2022;11:52131-531. https://doi.org/10.21037/apm-21-3710
Van Peppen RP, Kwakkel G, Wood-Dauphinee S, Hendriks HJ, Van der Wees P, Dekker J. The impact of physical therapy on functional outcomes after stroke: What 's the evidence? Clini Rehab 2004;18:833-62. https://doi.org/10.1191/0269215504cr843oa
Ramachandran VS, Rogers-Ramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proc R Soc B Biol Sci 1996;263:377-86. https://doi.org/10.1098/rspb.1996.0058
Gallese V, Fadiga L, Fogassi L, Rizzolatti G. Action recognition in the premotor cortex. Brain 1996;119:593-609. https://doi.org/10.1093/brain/119.2.593
Silveira JC, Costa VS, Clementino TC, Campos TF, Melo LP. Motor function improves in post-stroke patients submitted to mirror therapy. Revis Terap Ocup USP 2017;28:333-9. https://doi.org/10.11606/issn.2238-6149.v28i3p333-339
Hsieh YW, Lin YH, Zhu JD, Wu CY, Lin YP, Chen CC. Treatment effects of upper limb action observation therapy and mirror therapy on rehabilitation outcomes after subacute stroke: A pilot study. Beh Neurol 2020;2020:1-9. https://doi.org/10.1155/2020/6250524
Altschuler EL, Wisdom SB, Stone L, Foster C, Galasko D, Llewellyn ME, et al. Rehabilitation of hemiparesis after stroke with a mirror. Lancet 1999;353:2035-6. https://doi.org/10.1016/S0140-6736(99)00920-4
Folstein MF, Folstein SE, McHugh PR. Mini-mental state" A practical method for grading the cognitive state of patients for the clinician Related papers “MINI-MENTAL STATE” a practical method for grading the cognitive state of patients for the clinician. J Gsychiaf Res 1975;12:189-98. https://doi.org/10.1016/0022-3956(75)90026-6
Bohannon RW, Smith MB. Interrater Reliability of a Modified Ashworth Scale of Muscle Spasticity. Phys Ther 1987;67:206-7. https://doi.org/10.1093/ptj/67.2.206
Maki T, Quagliato E, Cacho E, Paz L, Nascimento N, Inoue M, et al. Estudo de confiabilidade da aplicação da escala de Fugl-Meyer no Brasil. Rev Bras Fisiot 2006;10:177-83. https://doi.org/10.1590/S1413-35552006000200007
Madhoun HY, Tan B, Feng Y, Zhou Y, Zhou C, Yu L. Task-based mirror therapy enhances the upper limb motor function in subacute stroke patients: a randomized controlled trial. Eur J Phys Rehab Med 2020;56:265-71. https://doi.org/10.23736/s1973-9087.20.06070-0
O'Sullivan SB, Schmitz TJ. Physical Rehabilitation. 5th ed. Philadelphia: F.A. Davis Company; 2007.
Marzke MW. Evolutionary development of the human thumb. Hand Clin 1992;8:1-8. https://pubmed.ncbi.nlm.nih.gov/1572915/
McPherson LM, Dewald JPA. Abnormal synergies and associated reactions post-hemiparetic stroke reflect muscle activation patterns of brainstem motor pathways. Front Neurol 2022;13:934670. https://doi.org/10.3389/fneur.2022.934670
Xu J, Ma T, Kumar S, Olds K, Brown J, Carducci J, et al. Loss of finger control complexity and intrusion of flexor biases are dissociable in finger individuation impairment after stroke. BioRxiv 2023.08.29.555444. https://doi.org/10.1101/2023.08.29.555444
Sainz-Pelayo MP, Albu S, Murillo N, Benito-Penalva J. Espasticidad en la patología neurológica. Actualización sobre mecanismos fisiopatológicos, avances en el diagnóstico y tratamiento. Rev Neurol 2020;70:453-60. https://doi.org/10.33588/rn.7012.2019474
Marsden J, Stevenson V, Jarret L. Treatment of spasticity. In: Aminoff MJ, Goetz CG (eds). Handbook Clin Neurol 2023;196:497-521. https://doi.org/10.1016/b978-0-323-98817-9.00010-7
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Copyright (c) 2025 Isadora Valacio Resende, Laiz Helena de Castro Toledo Guimarães

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Aprovado 2025-04-22
Publicado 2025-04-30
