Efeitos da bandagem elástica na propriocepção do ombro e desempenho sensório-motor durante atividade de beber em indivíduos hemiparéticos crônicos

Abstract

Background: Stroke is the second cause of death and the first cause of disability in the adult population worldwide. Although spontaneous motor recovery is observed, about 50% to 70% of hemiparetic individuals present alterations of the upper limb, impairing the performance of activities of daily living even after 2 to 4 years of stroke. Recently elastic tape (ET) has been widely used in clinical practice to promote sensorimotor facilitation. Objective: To evaluate the immediate effects of ET, applied to the paretic shoulder, on the joint position sense during movements of shoulder abduction and flexion and on the kinematic variables during the reach in chronic hemiparetic individuals Methods: A crossover and sham-controlled study was conducted with post-stroke patients who were randomly allocated into two groups: 1) those who received Sham Tape (ST) first and after one month they received Elastic Tape (ET); 2) those who received Elastic Tape (ET) first and after one month they received Sham Tape (ST). The JPS was evaluated using a dynamometer. The absolute error for shoulder abduction and flexion at 30° and 60° was calculated. Sensorimotor impairment was determined by Fugl-Meyer, and shoulder subluxation was measured using a caliper. Results: Thirteen hemiparetic subjects (average time since stroke 75.23 months) participated in the study. At baseline (before interventions), the groups were not different for abduction at 30° (p=0.805; p=0.951), and 60° (p=0.509; p=0.799), or flexion at 30° (p=0.872; p=0.897) and 60° (p=0.853; p=0.970). For the ET group, differences between pre and post-elastic tape for abduction at 30° (p<0.010) and 60° (p<0.010), and flexion at 30° p<0.010) and 60° (p<0.010) were observed. For the ST group, differences were also observed between pre and post-elastic tape for abduction at 30° (p<0.010) and 60° (p<0.010), and flexion at 30° (p<0.010,) and 60° (p<0.010). Potential effects were only correlated with shoulder subluxation during abduction at 30° (p=0.001, r=-0.92) and 60° (p=0.020, r=-0.75). Moreover, the elastic tape improved the shoulder position (more towards midline), reduced scapula protraction and trunk flexion at the beginning, during, and the end of the task, however without changing the spatiotemporal parameters. Moreover, an improvement in joint movement of shoulder elevation, scapula rotation and elbow extension was observed at specific time-instants during the task, for example, elbow extension from the middle of reaching and the transport phase from cup to table was increased. However, the effect size ranged from small to medium. Conclusion: Elastic tape improved shoulder JPS, UL joint motions and posture of subjects with chronic hemiparesis regardless of the level of UL sensorimotor impairment, which defines its role as adjuvant therapy. However, this improvement was influenced by the subluxation degree at abduction.