O não uso aprendido e sua influência na funcionalidade do membro superior afetado de indivíduos pós Acidente Vascular Cerebral

• Ano de defesa: 2020
• Autor(a) principal: Matuti, Gabriela da Silva
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Cidade de São Paulo; Brasil; Pós-Graduação; Programa de Pós-Graduação Mestrado em Fisioterapia; UNICID
• Palavras-chave em Português: Acidente Vascular Cerebral; Não uso aprendido; Motor Activity Log; Capacidade; Desempenho; Preditores; CNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL
• Link de acesso: https://repositorio.cruzeirodosul.edu.br/handle/123456789/2219

Background: Stroke is considered a worldwide epidemic. Among the post- stroke sequelae, hemiplegia is recurrent and more than 75% of the victims have upper limb involvement immediately after the event. Many individuals, even with motor improvement, persist with functional deficits. This is due to the difficulty in transposing a skill acquired in a clinical environment to real life, due to the installation of a phenomenon called learned nonuse. There is a gap in instruments for assessing the real use of the affected upper limb by Stroke, assessments of motor capacity do not seem to reflect what the individual actually does in their real life. The Motor Activity Log was translated and adapted to our culture, proved to be reliable, but its validity was affected by the limitation in evaluating more severely affected individuals. The use of instruments of capacity and motor performance facilitate the analysis of factors that can influence the recovery of these individuals. Knowledge of these predictive factors is important in clinical practice to guide decision making and favor the success of therapeutic interventions. Objectives: Analyze the relationship between motor capacity and performance, verify which activities tested in a clinical environment are able of predicting real use; and which daily activities are able of predicting the clinically important change in motor capacity, determining a cutoff point. Test the validity and responsiveness of the MAL- Brazil scale to assess the report of real use and the perception of the quality of this use of the affected upper limb in post-stroke individuals, in a chronic phase of the injury, with mild to moderate impairment. Methods: To analyze the objectives used, two studies, the first being retrospective longitudinal observational study. 110 participants referred for Constraint- Induced Movement Therapy (CIMT), diagnosed with stroke and evaluated with the Motor Activity Log-Brazil (MAL-Brazil) and Wolf Motor Function Test (WMFT) were included. The relationship between motor capacity and the report of real use was analyzed by Pearson's correlation and the linear and logistic regression analysis used to identify predictors of important clinical change. For the other objectives data from the medical records of 83 participants who underwent Constraint-Induced Movement Therapy were used for analysis. The divergent instruments used were the data of grip strength and pinch of the affected hand, Wolf Motor Function Test (WMFT) and Cannadian Occupational Performance Measure (COPM). Results: We observed in the first study weak relationship (p <0.01; r = 0.297) between WMFT and MAL-Brazil. Activity 12 of the WMFT was a predictor of the report of real use of MAL-Brazil (ß = -0.4; p <0.0001). Questions 26 and 29 from MAL-Brasil were predictive, together explaining 74% of the clinically important change in the WMFT, area under the ROC curve of 0.70 and cut-off point of ≤1. Regarding the analysis of the measurement properties of the second study the internal consistency for the frequency of use was α = 0.92, with a 50% floor effect and a 0% ceiling effect; and in the perception of quality of use α = 0.94, with a floor effect of 42% and a ceiling of 0%. The minimum detectable change of 0.25 was found for the frequency of use and 0.23 in the perception of quality of use. There was a significant correlation, magnitude and direction within the a priori hypotheses between the divergent instruments and MAL-Brazil, and between the two subscales r = 0.90. Responsiveness showed a large effect size and significant correlation, with adequate magnitude between divergent instruments, except in the frequency of use subscale, with the strength tests and in the quality of use perception subscale, with the WMFT speed and strength of the pinch. Conclusions: The relationship between the report of real use and the motor capacity of the affected upper limb in post-stroke individuals is weak. The task of flip cards was able to predict the report of real use, regardless of dominance. The activities of using a fork or spoon to eat and button a shirt are predictors of the clinical change in motor capacity after CIMT. MAL-Brazil demonstrated to be reliable, valid and responsiveness in measuring the report of real use of the affected upper limb and the perception of quality of this use, in individuals after stroke, in a chronic phase of the injury, with mild and moderate impairment , submitted to Constraint-Induced Movement Therapy.