Back to Farm: Jogo Sério para reabilitação motora pós-acidente vascular cerebral
DOI:
https://doi.org/10.34024/rnc.2025.v33.19808Palavras-chave:
Jogos de Vídeo, Extremidade Inferior, Reabilitação, Hemiparesia, Acidente Vacular CerebralResumo
Introdução. A hemiparesia é o quadro clínico clássico pós-AVC, envolvendo o comprometimento dos membros inferiores (MMII) e limitando a realização de tarefas essenciais da vida diária, o que afeta a funcionalidade e a qualidade de vida dos pacientes. Os Jogos Sérios (JS), são novas tecnologias para o tratamento, criados com um objetivo específico e adaptáveis às limitações dos pacientes, proporcionam uma reabilitação mais envolvente, desafiadora e motivadora. Objetivo. Avaliar os efeitos terapêuticos de um programa de exercícios com um JS que envolve a tarefa de sentar e levantar, desenvolvido para reabilitação motora dos MMII de pacientes com AVC. Método. Estudo Quase-Experimental do tipo Séries de Tempo, com 5 hemiparéticos crônicos pós-AVC, idade média de 70,8±5,2 anos. Foi aplicado um programa de exercícios para reabilitação dos MMII utilizando o JS Back to Farm, duas vezes por semana durante 10 semanas. Foram avaliadas: força muscular, mobilidade funcional, resistência dos MMII e percepção da qualidade de vida. Resultados. Não existiam diferenças na linha de base das variáveis estudadas, mostrando uma homogeneidade entre os participantes. Foram constatadas melhoras significantes e com grande tamanho de efeito (TDE) nas variáveis força muscular do quadríceps femoral parético (p=0,001; TDE=0,6) e resistência dos MMII (p<0,001; TDE=0,5). Conclusão. Embora preliminares, os resultados indicam que o JS Back to Farm pode ser utilizado na reabilitação pós-AVC, promovendo melhoras motoras dos MMII destes pacientes. Este recurso possibilita um treinamento intenso e orientado à tarefa, com alto nível de atenção do paciente, sem perder o componente motivacional caraterístico dos jogos no processo de reabilitação.
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Referências
1.Lenkulkul F, Franco G, Soares AV, Noveletto F, Domenech SC, Eichinger FLF. Serious game for rehabilitation of hemiparetic stroke patients: impact on quality of life. Res Soc Develop J 2022;11:e87111435976 https://doi.org/10.33448/rsd-v11i14.35976
2.Moraes MA, Jesus AP, Muniz LS, Baccin CA, Barreto ABM, Sales RS, Pires CGS, et al. Arrival time at a referral hospital and functional disability of people with stroke: a cohort study. SP Med J 2023;141:e2022510. https://doi.org/10.1590/1516-3180.2022.0510.R1.27022023
3.Souza FR, Sales M, Laporte LR, Melo A, Ribeiro NMS. Body structure/function impairments and activity limitations of post-stroke that predict social participation: a systematic review. Top Stroke Rehab 2023;30:589-602. https://doi.org/10.1080/10749357.2022.2095086
4.Korn R, Santos DF, Soares AV, Noveletto F, Eichinger FLF. Jogo Sério para reabilitação do equilíbrio de hemiparéticos por acidente vascular cerebral. Rev Neurocienc 2021;9:1-21. https://doi.org/10.34024/rnc.2021.v29.11333
5.Reis MF, Chaoubah A. The burden of stroke in the southeast region of Brazil in 2019: an estimate based on secondary data from the brazilian united health system. Inter J Cardiovasc Sci 2023;36: e20220116. https://doi.org/10.36660/ijcs.20220116
6.Alves AJM, Souza MV, Noveletto F, Soares AV, Eichinger FLF. Move Bit: um Jogo Sério que melhora a função motora do membro superior de hemiparéticos por AVC. Rev Neurocienc 2023;31:1-28. https://doi.org/10.34024/rnc.2023.v31.14682
7.Reis MF, Chaoubah A, Mármora CHC, Liebel G. Análise do gasto ambulatorial do acidente vascular cerebral na perspectiva do sistema público. J Bras Econ Saúde 2018;10:219-25. https://doi.org/10.21115/JBES.v10.n3.p219-25
8.Hadjiosif AM, Branscheidt M, Anaya MA, Runnalls KD, Keller J, Bastian AJ, et al. Neuroscience of Disease Dissociation between abnormal motor synergies and impaired reaching dexterity after stroke. J Neurophysiol 2022;127:856-68. https://doi.org/10.1152/jn.00447.2021
9.Silva CRR, Costa TF, Pontes MLF, Pimenta CJL, Bezerra TA, Ferreira Viana LRC, et al. Funcionalidade, estresse e qualidade de vida de sobreviventes de acidente vascular encefálico. Acta Pauli Enferm 2022;35:eAPE0390345. https://doi.org/10.37689/acta-ape/2022AO0390345
10.Harjpal P, Qureshi MI, Kovela RK, Jain M. Efficacy of bilateral lower-limb training over unilateral lower-limb training to reeducate balance and walking in post-stroke survivors: a randomized clinical trial. Cureus J Med Sci 2022;14:e30748. https://doi.org/10.7759/cureus.30748
11. WANG, S.; BHATT, T. Gait Kinematics and Asymmetries Affecting Fall Risk in People with Chronic Stroke: A Retrospective Study. Biomechanics 2022;2:453-465. https://doi.org/10.3390/biomechanics2030035
12.Rosa AT, Zonta MB, Lange MC, Zétola VHF. Qualidade de vida: preditores e desfechos após acidente vascular cerebral em um hospital público brasileiro. Arq Neuropsiquiatr 2023;81:2-8. https://doi.org/10.1055/s-0042-1758364
13.Eichinger FLF, Soares AV, Noveletto F, Bertemes Filho P, Domenech SC. Serious game for locomotor rehabilitation of hemiparetic stroke. Fisioter Movim 2020;33:e003316.
https://doi.org/10.1590/1980-5918.033.AO16
14.Henrique PPB, Colussi EL, Marchi ACB. Effects of exergame on patients' balance and upper limb motor function after stroke: a randomized controlled trial. J Stroke Cerebrovasc Dis 2019;28:2351-7. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.05.031
15.Minelli C, Luvizutto GJ, Cacho RO, Neves LO, Magalhães SCSA, Pedatella MTA, et al. Brazilian practice guidelines for stroke rehabilitation: Part II. Arq Neuropsiquiatr 2022;80:741-58.
https://doi.org/10.1055/s-0042-1757692
16.Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for adult stroke rehabilitation and recovery. Stroke 2016;47:98-169. https://doi.org/10.1161/STR.0000000000000098
17.Doumas I, Everard G, Dehem S, Lejeune T. Serious games for upper limb rehabilitation after stroke: a meta-analysis. J NeuroEng Rehab 2021;18:100. https://doi.org/10.1186/s12984-021-00889-1
18.Noveletto F, Soares AV, Eichinger FLF, Domenech SC, Hounsell SM, Bertemes Filho P. Biomedical Serious Game System for Lower Limb Motor Rehabilitation of Hemiparetic Stroke Patients. IEEE Trans Neural Syst Rehab Engin 2020;28:1481-7. https://doi.org/10.1109/TNSRE.2020.2988362
19.Ribeiro TG, Paz CCSC, Alencar RC, Costa YA. Treinamento orientado à tarefa e fisioterapia convencional na recuperação motora no pós-AVC. Rev Neurocienc 2020;28:1-15. https://doi.org/10.34024/rnc.2020.v28.10571
20.Soares AV, Noveletto F, Eichinger FLF, Júnior YS, Hounsell MS. New Technology for Physical Therapy: The Serious Games. Belo Horizonte: Synapse Editora; 2022; 22p.
21.Thomas JRS, Nelson JK, Silverman SJ. Métodos de pesquisa em atividade física. 6. ed. Porto Alegre: Artmed; 2012; 478p.
22.Bertolucci PHF, Brucki SMD, Campacci SR, Juliano Y. O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.
https://doi.org/10.1590/S0004-282X1994000100001
23.Cooper A, Alghamdi GA, Alghamdi MA, Altowaijri A, Richardson R. The relationship of lower limb muscle strength and knee joint hyperextension during the stance phase of gait in hemiparetic stroke patients. Physiother Res Inter 2011;17:150-6.
https://doi.org/10.1002/pri.528
24.Feijó GMS, Santos RV. Influência do tônus muscular na função do membro superior de indivíduos hemiparéticos. Rev Neurocienc 2020;28:1-20. https://doi.org/10.34024/rnc.2020.v28.10911
25.San Agustín RM, Crisostomo MJ, Sanchéz Martínez MP, Medina Mirapeix F. Responsiveness and minimal clinically important difference of the five times sit-to-stand test in patients with stroke. Inter J Environ Res Public Health 2021;18:2314. https://doi.org/10.3390/ijerph18052314
26.Cohen J. Statistical power analysis for the behavioral sciences. 2. ed. New York: Lawrence Erlbaum Associates; 1988.
https://doi.org/10.4324/9780203771587
27.Hyun SJ, Lee J, Lee BH. The Effects of Sit-to-Stand Training Combined with Real-Time Visual Feedback on Strength, Balance, Gait Ability, and Quality of Life in Patients with Stroke: A Randomized Controlled Trial. Inter J Environ Res Public Health 2021;18:e37506
28.Barbanera M, Rodrigues DN, Cardoso FS, Marco AL, Franciulli PM, Francica JV, et al. Comparative study of virtual rehabilitation and kinesiotherapy for knee torque among the elderly. Acta Fisiátr 2015;21:171-6. https://doi.org/10.5935/0104-7795.20140034
29.Shen KH, Borrelli J, Gray VL, Rogers MW, Hsiao HY. Lower limb vertical stiffness and frontal plane angular impulse during perturbation-induced single limb stance and their associations with gait in individuals post-stroke. J Biomechan 2024;163:111917. https://doi.org/10.1016/j.jbiomech.2023.111917
30.Hernandez A, Bubyr L, Archambault PS, Higgins J, Levin MF, Kairy D. Virtual Reality–Based Rehabilitation as a Feasible and Engaging Tool for the Management of Chronic Poststroke Upper-Extremity Function Recovery: Randomized Controlled Trial. JMIR Serious Games 2022;10: e37506. https://doi.org/10.2196/37506
31.Zhang B, Li D, Liu Y, Wang J, Xiao Q. Virtual reality for limb motor function, balance, gait, cognition and daily function of stroke patients: A systematic review and meta-analysis. Leading Global Nursing Res 2021;77:3255-73. https://doi.org/10.1111/jan.14800
32.Anwar N, Karimi H, Ahmad A, Mumtaz N, Saqulain G, Gilani SA. A Novel Virtual Reality Training Strategy for Poststroke Patients: A Randomized Clinical Trial. J Healthcare Engin 2021;2021:6598726.
https://doi.org/10.1155/2021/6598726
33.Almutairi SM, Khalil ME, Almutairi N, Alsaadoon SM, Alharbi DS, Al Assadi SD, et al. Effects of Neuromuscular Electrical Stimulation on Spasticity and Walking Performance among Individuals with Chronic Stroke: A Pilot Randomized Clinical Trial. Healthcare 2023;11:3137.
https://doi.org/10.3390/healthcare11243137
34.Oliveira MPB, Ferreira DM, Silva JRT, Silva AM, Lobato DFM, Kosour C, et al. Virtual reality applied to the lower limb motor function in post-stroke individuals. Acta Fisiátr 2016;23:135-9.
https://doi.org/10.5935/0104-7795.20160026
35.Sahely A, Sintler C, Soundy A, Rosewilliam S. Feasibility of a self-management intervention to improve mobility in the community after stroke (SIMS): A mixed-methods pilot study. PLoS One 2024;19:e0286611. https://doi.org/10.1371/journal.pone.0286611
36.Queiroz LL, Silva LGO, Pinheiro HA. O Timed Up and Go Test pode ser utilizado como preditor da força muscular em idosos? Fisioter Pesq 2023;30:e22013723pt. https://doi.org/10.1590/1809-2950/e22013723pt
37.Santos FMK, Eichinger FLF, Domenech SC, Noveletto F, Engster MP, Aquino APM, et al. Jogo sério para treinamento do equilíbrio em pacientes hemiparéticos por acidente vascular cerebral. Res Soc Developm 2022;11:e571111433600. https://doi.org/10.33448/rsd-v11i14.33600
38.Corbetta D, Imeri F, Gatti R. Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review. J Physiother 2015;61:117-24. https://doi.org/10.1016/j.jphys.2015.05.017
39.Souza D, Harvey LA, Dorsch S, Varettas B, Jamieson S, Murphy A, et al. Two weeks of intensive sit-to-stand training in addition to usual care improves sit-to-stand ability in people who are unable to stand up independently after stroke: a randomized trial. J Physiother 2019;65:152-8. https://doi.org/10.1016/j.jphys.2019.05.007
40.Liu M, Chen J, Fan W, Mu J, Zhang J, Wang L, et al. Effects of modified sit-to-stand training on balance control in hemiplegic stroke patients: A randomized controlled trial. Clin Rehab 2015;30:627-36. https://doi.org/10.1177/0269215515600505
41.Villa RF, Ferrari F, Moretti A. Post-stroke depression: Mechanisms and pharmacological treatment. Pharmacol Therapeut 2018;184:131-44. https://doi.org/10.1016/j.pharmthera.2017.11.005
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Copyright (c) 2025 Daiana Cristina Novotni Fagundes, Rebeca Mano Pereira da Rocha, Fabrício Noveletto, Márcia Regina Garcia Gugelmin, Antonio Vinicius Soares, Fernando Luís Fischer Eichinger
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
