Efeitos imediatos da crioterapia sobre o desempenho neuromuscular da articulação do tornozelo e o padrão da marcha de indivíduos hemiparéticos espásticos crônicos Pós-AVE

Abstract

Introduction: Stroke has been described as the third leading cause of death and the leading cause of disability in the adult population worldwide. Deficits in lower limb functions often persist in the vast majority of cases, affecting gait and functional mobility. In this context, several interventions are applied in the clinical practice to optimize functional performance. Cryotherapy is among the techniques used in order to temporarily reduce spasticity, allowing the performance of functional training, such as walking. However, its effects on muscle tone, muscle performance and gait pattern of individuals with chronic hemiparesis have not yet been elucidated. Objectives: To investigate the immediate effects of cryotherapy (ice pack) on muscle tone, isometric and isokinetic torque of the dorsiflexor and plantar flexor muscles, and angular and spatiotemporal gait parameters in chronic spastic hemiparetic individuals. Methods: Experimental design: randomized crossover controlled study. Participants: Sixteen chronic hemiparetic subjects. Intervention: Cryotherapy (ice pack) or Control Intervention (sand pack at room temperature) applied on the plantar flexor muscles of the paretic limb. Assessments (pre / post intervention): 1) Muscle tone, according to the Modified Ashworth Scale (MAS); 2) Spatiotemporal parameters and angular kinematics of the hip, knee and ankle (flexion / extension) during gait obtained through a three-dimensional motion analysis system (Qualisys); 3) Isometric, concentric and eccentric torque of dorsiflexion and flexorplantar, evaluated in isokinetic dynamometer. Statistical analysis: Two-way repeated measures ANOVA test was used to analyze all kinematic and torque variables. Non-parametric Wilcoxon and Mann-Whitney tests were used for comparisons of the score in the MAS, since it is considered a categorical variable. Significance level of 0.05 was considered for all statistical analysis. Results: Cryotherapy reduced the tone of the plantar flexors, but did not alter the capacity of torque generation or spatiotemporal and angular parameters (sagittal plane) during gait compared to the control intervention. Conclusion: The findings of this study suggest that cryotherapy (ice pack) applied on the plantar flexor muscles of individuals with chronic hemiparesis appears to be an effective technique to reduce muscle tone clinically measured but does not affect muscle performance and gait pattern of these individuals.