O efeito da terapia de restrição induzida do movimento no membro superior parético sobre a excitabilidade central e periférica após acidente vascular encefálico

Abstract

Restriction Induced Movement Therapy (RIMT) is one of therapies for treatment of people after stroke. It contributes to motor learning and promotes neural recovery after stroke. Thus, the objective was to evaluate the effect of RIMT on central and peripheral excitability related to paretic upper limb after stroke. It is a simple blinded clinical trial, composed of 22 volunteers with stroke who were divided into Experimental Group (EG - n = 11), who performed the RIMT with the non-affected limb and contained trunk and Control Group (CGn = 11), where the volunteers performed conventional physiotherapy. Both groups were evaluated before and after intervention for Fugl-Meyer motor impairment, muscular electrical activity of biceps brachii, extensor and flexor muscles of fingers through surface electromyography and central excitability through electroencephalography. Subjects were trained for two consecutive weeks, except the weekend, for 60 minutes each session. For training, the Shaping protocol was used. During training, task execution time was individually timed for analysis. The results showed a significant intragroup increase (p = 0.041) on the Fugl-Meyer scale in the EG after training. There was a significant reduction in the execution time of tasks 1X5 (p = 0.000), 1X6 (p = 0.026) and 1X10 (p = 0.009) sessions and increase between 5X6 (p = 0.017) sessions. Analysis of the peripheral excitability indicated intergroup differences in the brachial biceps, AV1 (p = 0.039), and the finger extensor in AV2 (p = 0.026), both with higher CG values. Central excitability results indicated activation of alpha wave in both groups, in the assessment and reassessment, in all motor and pre-motor canals in the right and left hemispheres, disregarding the affected laterality. In the second assessment (AV2) of left hemisphere there was an intergroup difference (p = 0.028) of frequency in FC5 channel with a lower value in EG and in relation to activation power of alpha wave there was an intergroup difference (p = 0.004) with higher value in EG. In the first assessment (AV1) of right hemisphere, there was a significant difference (p = 0.024) in the frequency of activation in channel F4 with higher value in EG. In the intragroup comparison of affected hemisphere, the CG presented a significant increase between the times (p = 0.014) in FC channel. In the intergroup comparison of the hemisphere affected, in the AV1, the EG presented higher frequency value in Fa channel (p = 0.035) in relation to the CG. In AV2, the EG presented lower value in the FC channel (p = 0.004) in relation to the CG. Also in reevaluation, only in CG, moderate positive correlation between the flexor finger and the pre-motor area, as well as moderate negative correlation between the finger extensor and the primary motor area in both evaluation and reevaluation. It is concluded that RIMT associated with trunk restraint promoted a change in peripheral excitability for brachial muscle and extensor fingers muscle and promoted a change in central excitability, especially for the FC channel for the superior paretic in individuals affected by stroke.