Banca de DEFESA: RENATA JANAÍNA PEREIRA DE SOUZA

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : RENATA JANAÍNA PEREIRA DE SOUZA
DATE: 27/05/2021
TIME: 13:00
LOCAL: videoconferência
TITLE:

REPERCUSSIONS OF THE PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION ASSOCIATED WITH CARDIORRESPIRATORY TRAINING IN POST STROKE INDIVIDUALS: CONTROLLED RANDOMIZED CLINICAL TRIAL

KEY WORDS:

Stroke; Rehabilitation; Breathing Exercises; Proprioceptive Neuromuscular Facilitation; Gait

PAGES: 111
BIG AREA: Ciências da Saúde
AREA: Fisioterapia e Terapia Ocupacional
SUMMARY:

Background:

Individuals after a stroke present alterations in several physiological systems such as the musculoskeletal and cardiopulmonary systems. These systemic changes have important repercussions such as a significant reduction in the distance covered in the 6-minute walk test, respiratory function and in the distribution of lung volumes. These patients also show a reduction in their level of physical activity, which in turn leads to a negative impact on mobility, inability to perform activities of daily living and quality of life.

Cardiorespiratory training (CRT) is considered one of the means of improving cardiorespiratory capacity in this population, however, as it is a population that presents important changes in respiratory mechanics, the isolated use of CRT may be insufficient. Thus, the addition of the Proprioceptive Neuromuscular Facilitation (PNF) technique, which emphasizes stretching in the various diameters of the trunk would imply greater awareness and harmony of the functions performed by the trunk, focusing on the respiratory muscles of that individual, thus promoting an improvement in function respiratory capacity of these patients and helping to increase the cardiorespiratory capacity of these individuals.

Objectives:

a) Develop a randomized clinical trial protocol designed to verify the effects of adding PNF to a TCR on the respiratory function of post-stroke individuals;

b) To investigate whether changes in the volume of the rib cage (at rest and during inspiratory maneuver) in post-stroke patients are related to functional changes in the distance covered in the 6-minute walk test, respiratory muscle strength and lung function.

c) Evaluate the effects of the breathing and trunk patterns of Proprioceptive Neuromuscular Facilitation associated with cardiorespiratory training on quality of life, gait, distance covered, peak oxygen consumption, respiratory muscle strength, chest volumes, of individuals with post-stroke.

Materials and methods: Firstly, a protocol for the clinical trial was developed, with the evaluations and interventions to be carried out by the volunteers. It also established the eligibility criteria for subsequent studies. Individuals diagnosed with primary stroke for more than 6 months and with hemiparesis, of both sexes and aged between 21-65 years were evaluated regarding outcome measures measured by: Specific Quality of Life Scale - Stroke ( SSQoL); Maximum volume of Oxygen; 6-minute walk test (6MWT); Berg's Balance Scale (BBS); spirometry and manovacuometry; compartmental volumes of the rib cage with optoelectronic plethysmography. From the initial evaluations, a cross-sectional observational study and a clinical trial, randomized, blinded and with allocation confidentiality, were carried out, all developed at the Laboratory of Cardiopulmonary Physiotherapy Department of Physiotherapy at the Federal University of Pernambuco (UFPE). In the clinical trial, post-stroke individuals were randomized into four groups: Experimental LLLL (subjected to lower limb CRT associated with PNF); LLLL Control Group (submitted to LL CRT associated with breathing). Experimental UULL (submitted to upper limb CRT associated with PNF) and UULL Control Group (submitted to UULL CRT associated with breathing). The subjects were evaluated before and immediately after 20 sessions of the treatment program and one month after the end of treatment. For the four groups, the treatment program consisted of performing PNF breathing patterns or breathing, followed by 30 minutes of aerobic treatment and repetition of the respiratory part, being performed in 20 sessions, three times a week. The determination of the referral for the techniques was made by means random form, being maintained until the end of the intervention period. For therapy with the CRT, a cycle ergometer for lower or upper limbs was used, based on the criteria of the American College of Sports Medicine and constant monitoring of blood pressure, oxygen saturation, heart rate and perceived exertion. PNF patterns were performed in the sitting, supine, ventral and lateral positions. Breathing exercises were performed for the same time and in the same positions as the PNF.

Results:

Clinical trial protocol: Addition of proprioceptive neuromuscular facilitation to cardiorespiratory training in patients poststroke: study protocol for a randomized controlled trial (https://doi.org/10.1186/s13063-019-3923-1)

In the cross-sectional study, 17 volunteers were evaluated, aged 55 (7.5) years, 22 (17) months after stroke, 207 (119) meters covered in the 6MWT, and tidal volumes in quiet breathing and inspiratory capacity of 460 (160) and 1,790 (460) ml respectively. No correlation was found between the distance in the 6MWT and the volume distribution of chest wall at rest. During the inspiratory capacity maneuver, an increased abdominal volume was related to a shorter distance covered.

Sixteen individuals underwent training in the pilot of the clinical trial. The analyzes were performed using ANOVA of repeated measure LLLL with and without PNF. There was no significant difference between the groups of different interventions, except for compartmental volumes of abdominal and abdominal ribs in the lower limbs groups, in the control group. The values of Forced Expiratory Volume in the 1st second (FEV1) and FEV1 / Forced Vital Capacity in the upper limbs groups were significantly higher in the control group.

Conclusion - Individuals after stroke show a reduction in the distance covered on the 6MWT when there is an increase in the volume of the abdominal compartment.

The FNP and control groups showed similar behaviors in relation to functional, respiratory, and quality of life variables of the individuals in the sample.

BANKING MEMBERS:
Externo à Instituição - ANTONIO JOSÉ SARMENTO DA NÓBREGA
Presidente - 275.782.084-20 - ARMELE DE FATIMA DORNELAS DE ANDRADE - UFPE
Externo à Instituição - ETIENE OLIVEIRA DA SILVA FITTIPALDI - UFPE
Interno - 350637 - RICARDO OLIVEIRA GUERRA
Interna - 1149619 - SELMA SOUSA BRUNO