Avaliação dos efeitos a longo prazo da acupuntura e exercícios terapêuticos em ombro congelado de pacientes com acidente cerebral vascular

Autores

  • Aleksandra Plavsic Universidade de Roma Tor Vergata
  • Calogero Foti Universidade de Roma Tor Vergata
  • Gessica Della Bella Universidade de Roma Tor Vergata
  • Zorica Brdareski Academia Médica Militar, Belgrado
  • Ljubica Nikcevic Hospital Saint Sava, Belgrado
  • Ljubica Konstantinovic

Palavras-chave:

Acidente Vascular Cerebral, Acupuntura, Reabilitação

Resumo

Objetivo: Determinar como a acupuntura e a terapia com exercícios afetam a função motora e espasmodicidade das mãos de pacientes com acidente cerebral vascular 6 meses após eles terem recebido este tipo de terapia. Métodos: Estudo clínico prospectivo, aleatório e cego de 20 pacientes, com idades entre 60-70 anos, na fase crônica de 6 meses após o AVC. Os sujeitos do estudo foram divididos em dois grupos: Grupo A, o qual foi tratado com acu-puntura e terapia de exercícios (AP-ET) 6 meses atrás e Grupo B, o qual foi tratado apenas com terapia de exercícios (ET) 6 meses atrás. Resultados: As análises mostraram uma diferença estatisticamente significativa nos SCORES do pós-tratamento em comparação com 6 meses após o tratamento com cada grupo de estudo, para todos os parâmetros examinados (p<0.01 em todos os casos) exceto pelo MAS. As análises mostraram uma diferença estatisticamente significativa em alguns parâmetros no grupo ET em comparação ao grupo AP-ET com valores médios maiores no grupo AP-ET para MAS e CSDQ. Todos os outros parâmetros não mostraram nenhuma diferença estatística entre os grupos diferentes de terapia 6 meses após a terapia. Conclusão: Os resultados confirmam a hipótese de que a acupuntura e a terapia de exercícios são úteis no tratamento de ombro congelado em pacientes com AVC e que seus efeitos ainda estão presentes após seis meses de terapia, no entanto, dado o pequeno número de pacientes, mais estudos são necessários para verificar estes resultados.

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Referências

Bunker TD. Time for a new name for 'frozen shoulder'. Br Med J (Clin Res Ed). 1985;290(6477):1233-4.

Tukmachi E. Frozen shoulder: a comparison of western and traditional Chinese approaches and a clinical study of its acupuncture treatment. Acupunct Med.1999;17(1):9-21.

Teasell RW, Heitzner JD. The painful hemiplegic shoulder. Phys Med Rehabil State Art Rev. 1998;12(3):489-500.

Forster A. The painful hemiplegic shoulder: physiotherapy treatment. Rev Clin Gerontol. 1994;4:343-8.

Wanklyn P, Forster A, Young J. Hemiplegic shoulder pain (HSP): natural history and investigation of associated features. Disabil Rehabil. 1996;18(10):497-501.

Poduri KR. Shoulder pain in stroke patients and its effect on rehabilitation. J Stroke Cerebrovascular Dis. 1993;3:261-6.

NIH Consensus Conference. Acupuncture. JAMA. 1998;280(17):1518-24.

Ernst E, White AR. Acupuncture as an adjuvant therapy in stroke rehabilitation? Wien Med Wochenschr. 1996;146(21-22):556-8.

Song JC, Jung SH, Lee JS, Kim SS, Shin HD. Clinical study of the effect of electroacupuncture on shoulder pain of cerebrovascular attack patients. J Oriental Rehabil Med 1999;9:41-57.

Yin CS, Nam SS, Kim YS, Lee JD, Kim CH, Koh HK. Effects of honey bee venom acupuncture therapy on poststroke hemiplegic shoulder pain. J Kor Inst Herbal Acu 2000;3:213-32.

Brunnstrom S. Movement therapy in hemiplegia: a neurophysiologic approach. New York: Harper & Row; 1970.

Hamilton BB, Granger CV, Sherwin FS, Zielezny M, Tashman JS. A uniform national data system for medical rehabilitation. In: Fuhrer MJ. Rehabilitation outcomes: analysis and measurement. Baltimore: Brookes; 1987. p. 137-47.

Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206-7.

Wijman CA, Stroh KC, Van Doren CL, Thrope GB, Peckham PH, Keith MW. Functional evaluation of quadriplegic patients using a hand neuroprosthesis. Arch Phys Med Rehabil. 1990;71(13):1053-7.

Popović D, Stojanović A, Pjanović A, Radosavljević S, Popović M, Jović S, et al. Clinical evaluation of the bionic glove. Arch Phys Med Rehabil. 1999;80(3):299-304.

Taub E, Miller NE, Novack TA, Cook EW 3rd, Fleming WC, Nepomuceno CS, et al. Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil. 1993;74(4):347-54.

Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13-31.

Croft P, Pope D, Zonca M, O'Neill T, Silman A. Measurement of shoulder related disability: results of a validation study. Ann Rheum Dis. 1994;53(8):525-8.

Plavsic A, Foti C, Brdareski Z, Nikcevic LJ. Clinical effects of acupuncture and exercise therapy in the treatment of frozen shoulder in the subacute phase after a stroke. In: 16th European Congress of Physical and Rehabilitation Medicine; 2008; Brugge. Proceedings. Brugge: European Society of Physical and Rehabilitation Medicine; 2008. p.128-30.

Stein J. Stroke. In: Frontera W, Slovik D, Dawson D, editors. Exercise in rehabilitation medicine. 2nd ed. Champaign: Human Kinetics; 2005. p.206-20.

Sällström S, Kjendahl A, Osten PE, Stanghelle JH, Borchgrevink CF. Acupuncture in the treatment of stroke patients in the subacute stage: a randomized, controlled study. Complement Ther Med.1996;4:193-7.

Johansson K, Lindgren I, Widner H, Wiklund I, Johansson BB. Can sensory stimulation improve the functional outcome in stroke patients? Neurology. 1993;43(11):2189-92.

Emperor's College to study acupuncture for stroke rehabilitation [editorial]. Acupuncture Today. 2000;1(5):1-2.

Alexander DN, Cen S, Sullivan KJ, Bhavnani G, Ma X, Azen SP. Effects of acupuncture treatment on poststroke motor recovery and physical function: a pilot study. Neurorehabil Neural Repair. 2004;18(4):259-67.

Cailliet R. The shoulder in the hemiplegic patient. In: Shoulder pain. 3rd ed. Philadelphia: FA Davis: 1991. p.193-226.

Hanger HC, Whitewood P, Brown G, Ball MC, Harper J, Cox R, et al. A randomized controlled trial of strapping to prevent post-stroke shoulder pain. Clin Rehabil. 2000;14(4):370-80.

Ezzo J, Berman B, Hadhazy VA, Jadad AR, Lao L, Singh BB. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain. 2000;86(3):217-25.

Willer JC, Roby A, Le Bars D. Psychophysical and electrophysiological approaches to the pain-relieving effects of heterotopic nociceptive stimuli. Brain. 1984;107(Pt 4):1095-112.

Andersson SA, Ericson T, Holmgren E, Lindqvist G. Electro-acupuncture. Effect on pain threshold measured with electrical stimulation of teeth. Brain Res. 1973;63:393-6.

Sandkühler J. The organization and function of endogenous antinociceptive systems. Prog Neurobiol. 1996;50(1):49-81.

Mayer DJ. Biological mechanisms of acupuncture. Prog Brain Res. 2000;122:457-77.

Kjendahl A, Sällström S, Osten PE, Stanghelle JK, Borchgrevink CF. A one year follow-up study on the effects of acupuncture in the treatment of stroke patients in the subacute stage: a randomized, controlled study. Clin Rehabil. 1997;11(3):192-200.

Fink M, Rollnik JD, Bijak M, Borstädt C, Däuper J, Guergueltcheva V, et al. Needle acupuncture in chronic poststroke leg spasticity. Arch Phys Med Rehabil. 2004;85(4):667-72.

Green S, Buchbinder R, Hetrick S. Acupuncture for shoulder pain. Cochrane Database Syst Rev. 2005;(2):CD005319.

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Publicado

2009-09-09

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Artigo Original