Palabras clave
accidente cerebrovascular
espasticidad muscular
fisioterapia
rehabilitación
Cómo citar
Resumen
Introducción: En la enfermedad cerebro vascular uno de los principales problemas es la espasticidad, que compromete el control postural, la funcionalidad y la calidad de vida. Para lograr la mayor recuperación funcional, se han utilizado los enfoques neuromusculares del ejercicio terapéutico (Ej: Rood, Bobath, Brunnstrom y la Facilitación Neuromuscular Propioceptiva), sin embargo, existe controversia sobre la eficacia de estas intervenciones. Objetivo: Realizar un análisis crítico de la evidencia científica disponible sobre el efecto de los enfoques tradicionales en la espasticidad de los miembros inferiores en personas post-Enfermedad Cerebro Vascular. Métodos: Se incluyeron ensayos clínicos controlados de las bases de datos PUBMED, MEDLINE, PEDro, CINAHL, SCIENCEDIRECT y SCOPUS. La calidad metodológica de los artículos incluidos se evaluó por medio de la escala PeDro. Resultados: Once estudios cumplieron con los criterios de inclusión, obteniendo una calidad metodológica de intermedia a alta. Entre las limitaciones de los estudios revisados se destacan principalmente la ausencia del cálculo del tamaño de muestra, de enmascaramiento de los evaluadores, pérdida de participantes, muestras heterogéneas, carencia de protocolos estandarizados y diversidad de variables evaluadas. Conclusión: El tratamiento fisioterapéutico para disminuir la espasticidad puede ser efectivo aplicado entre tres y cinco días por semana, durante 40 minutos. Sin embargo, estos resultados están soportados en estudios con limitaciones metodológicas y dificultades en su comparación. Por ello, se requieren nuevos estudios para evaluar la eficacia de dichos enfoques, con el fin implementar intervenciones fisioterapéuticas basadas en la mejor evidencia, que contribuyan en una mejor calidad de vida de esta población
Referencias
Organización Mundial de la Salud. Global status report on noncommunicable diseases 2010. Publications of the World Health. Switzerland. Report No.: ISBN 9789241564229.
Hancock N, Kilbride C. National clinical guideline for stroke. R Coll Physicians, UK. 2012.
Orozco J. Enfermedad Cerebro Vascular. In: Ministerio de la Protección Social Guías para manejo de urgencias Tomo III. 3rd ed. Bogota; 2009. 169-177.
Burridge JH, Wood DE, Hermens HJ, Voerman GE, Johnson GR, van Wijck F, et al. Theoretical and methodological considerations in the measurement of spasticity. Disabil Rehabil. 2005; 27(1-2): 69–80. DOI: http://dx.doi.org/10.1080/09638280400014592.
Bhimani RH, Anderson LC, Henly SJ, Stoddard SA. Clinical measurement of limb spasticity in adults. J Neurosci Nurs. 2011; 43(2): 104-115. DOI: https://doi.org/10.1097/jnn.0b013e31820b5f9f.
Ward AB. A literature review of the pathophysiology and onset of post-stroke spasticity. Eur J Neurol. 2012; 19(1): 21-27. DOI: https://doi.org/10.1111/j.1468-1331.2011.03448.x.
Wissel J, Schelosky LD, Scott J, Christe W, Faiss JH, Mueller J. Early development of spasticity following stroke: A prospective, observational trial. J Neurol. 2010; 257(7): 1067-1072. DOI: https://
doi.org/10.1007/s00415-010-5463-1.
Sommerfeld DK, Eek EUB, Svensson AK, Holmqvist LW, Von Arbin MH. Spasticity after Stroke: Its Occurrence and association with motor impairments and activity limitations. stroke. 2004; 35(1): 134-139. DOI: https://doi.org/10.1161/01. str.0000105386.05173.5e.
Urban PP, Wolf T, Uebele M, Marx JJ, Vogt T, Stoeter P, et al. Occurence and clinical predictors of spasticity after ischemic stroke. Stroke. 2010; 41(9): 2016-2220.
DOI: https://doi.org/10.1161/strokeaha.110.581991.
Shilt J, Seibert P, Kadyan V. Optimal management for people with severe spasticity. Degener Neurol Neuromuscul Dis. 2012; 2: 133-140. DOI: https://doi.org/10.2147/dnnd.s16630.
Faist M, Berger W, Dietz V. Changes in mechanical muscle fibre properties may contribute to spastic muscle hypertonia. Ann Readapt Med Phys. 1999; 42(8): 493-496.
DOI: https://doi.org/10.1016/s0168-6054(00)87703-x.
Bhimani R, Anderson L. Clinical understanding of spasticity: implications for practice. Rehabil Res Pract. 2014; 2014(278175): 1-10. DOI: https://doi.org/10.1155/2014/279175.
Van De Port I, Kwakkel G, Schepers V, Lindeman E. Predicting mobility outcome one year after stroke: a prospective cohort study. J Rehabil Med. 2006; 38(4): 218-223.
DOI: https://doi.org/10.1080/16501970600582930.
Kwakkel G, Kollen BJ. Predicting activities after stroke: What is clinically relevant? Int J Stroke. 2013; 8(1): 25–32. DOI: https://doi.org/10.1111/j.1747-4949.2012.00967.x.
Martin A, Abogunrin S, Kurth H, Dinet J. Epidemiological, humanistic, and economic burden of illness of lower limb spasticity in adults: a systematic review. Neuropsychiatr Dis Treat. 2014;
: 111-122.
DOI: https://doi.org/10.2147/ndt.s53913.
Aggarwal D, Walia S, Noohu M. Effect of plantarflexor spasticity and ankle joint range of motion on sit to stand movement in stroke patients. Physiother Occup Ther J. 2013; 6(1): 5-13.
Lee Y, Her JG, Choi Y, Kim H. Effect of Ankle-foot orthosis on lower limb muscle activities and static balance of stroke patients Authors’ Names. J Phys Ther Sci. 2014; 26(2): 179-182. DOI: https://doi. org/10.1589/jpts.26.179.
Ada L, Vattanasilp W, O’Dwyer NJ, Crosbie J. Does spasticity contribute to walking dysfunction after stroke?. J Neurol Neurosurg Psychiatry. 1998; 64: 628-635. DOI: https://doi.org/10.1136/
jnnp.64.5.628.
Schmid Arlene A, Klar Yaggi H, Burrus N, McClain V, Austin C, Ferguson J, et al. Circumstances and consequences of falls among people with chronic stroke. J Rehabil Res Dev. 2013; 50(9): 1277-1285. DOI: https://doi.org/10.1682/jrrd.2012.11.0215.
Peppen R Van, Kwakkel G, Wood-Dauphinee S. The impact of physical therapy on functional outcomes after stroke: what´s the evidence?. Clin Rehabilitation. 2004; 18: 833-862.
DOI: doi/abs/10.1191/0269215504cr843oa.
Pollock A, Baer G, Langhorne P, Pomeroy V. Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke: a systematic review. 2007; 21: 395-410. DOI: https://doi.org/10.1177/0269215507073438.
Chung B. Effect of different combinations of physiotherapy treatment approaches on functional outcomes in stroke patients: a retrospective analysis. Hong Kong Physiother J. 2014; 32(1): 21-27. DOI: https://doi.org/10.1016/j.hkpj.2013.11.001.
Trombly C. Occupational therapy for physical dysfunction. 4ed ed. United States of America: Williams & Wilkins; 1995. 446-460.
Umphred D. Remediating Motor Control and Performance Through Traditional Therapeutic Approaches. En: Neurological Rehabilitation. 5ed ed. United States of America: Churchill Livingstone; 2007. 433.
O´Sullivan S, Schmit T. Improving functional outcomes in physical rehabilitation. Philadelphia: Davis Company; 2010. 25-40.
Carr J, Shepherd R. Neurological Rehabilitation. Optimizing Motor Performance. 2ed. Ed. Churchill Livingstone; 2010. 77-83.
Katalinic OM, Harvey LA, Herbert RD, Katalinic OM, Harvey LA, Herbert RD. Effectiveness of stretch for the treatment and prevention of contractures in people with neurological conditions:
a systematic review. 2011; 91(1): 11-24.
DOI: https://doi.org/10.2522/ptj.20100265.
Stokes M. Fisioterapia en la rehabilitación neurológica. 2 ed. Madrid: Elsevier; 2006.
Platz T, Eickhof G, Vuadens P. Platz T. Clinical scales for the assessment of spasticity, associated phenomena, and function: a systematic review of the literature. Disabil Rehabil. 2005; 27: 7-18. DOI:https://doi.org/10.1080/09638280400014634.
Lee M, Wong M, Tang F, Cheng P, Lin P. Comparison of balance responses and motor patterns during sit-to-stand task with functional mobility in stroke patients. Am J Phys Med Rehabil. 1997; 76(5):
-410. DOI: https://doi.org/10.1097/00002060-199709000-00011.
Teixeira L, Olney S, Brouwer B. Mecanismos e medidas de espasticidade. Fisioter Pesqui. 1998; 5:4-19.
Voerman GE, Gregoric M, Hermens HJ. Neurophysiological methods for the assessment of spasticity: the Hoffmann reflex, the tendon reflex, and the stretch reflex. Disabil Rehabil.
; 27(1-2): 33–68. DOI: https://doi.org/10.1080/09638280400014600.
Kwakkel G, Van Peppen R, Wagenaar RC, Dauphinee SW, Richards C, Ashburn A, et al. Effects of augmented exercise therapy time after stroke: a meta-analysis. Stroke. 2004; 35(11): 2529-2536. DOI: https://doi.org/10.1161/01.str.0000143153.76460.7d.
Pollock A, Baer G, Campbell P, Choo P, Forster A, Morris J, et al. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst Rev. 2014; 4:
CD001920. DOI: https://doi.org/10.1002/14651858.cd001920.pub3.
Langhammer B, Stanghelle JK. Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study. Clin Rehabil. 2000; 14(4): 361-369.
DOI: https://doi.org/10.1191/0269215500cr338oa.
Green J, Forster A, Bogle S, Young J. Physiotherapy for patients with mobility problems more than 1 year after stroke: A randomised controlled trial. Lancet. 2002; 359(9302): 199-203. DOI: https://doi.
org/10.1016/s0140-6736(02)07443-3.
Kwakkel G, Wagenaar RC. Effect of duration of upper- and lower-extremity rehabilitation sessions and walking speed on recovery of interlimb coordination in hémiplégie gait. Phys Ther. 2002; 82(5): 432-448. DOI: https://doi.org/10.1093/ptj/82.5.432.
Fang Y, Chen X, Li H, Lin J, Huang R, Zeng J. A study on additional early physiotherapy after stroke and factors affecting functional recovery. Clin Rehabil. 2003; 17(6): 608-617. DOI: https://doi.org/10.1191/0269215503cr655oa.
Duncan P, Studenski S, Richards L, Gollub S, Lai SM, Reker D, et al. Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke. 2003; 34(9): 2173-2180. DOI:https://doi.org/10.1161/01.str.0000083699.95351.f2.
Eich H-J, Mach H, Werner C, Hesse S. Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial. Clin Rehabil. 2004; 18(6): 640-651.
DOI: https://doi.org/10.1191/0269215504cr779oa.
van Vliet PM, Lincoln NB, Foxall A. Comparison of Bobath based and movement science based treatment for stroke: a randomised controlled trial. J Neurol Neurosurg Psychiatry. 2005; 76(4): 503-508. DOI: https://doi.org/10.1136/jnnp.2004.040436.
Wang RY, Chen HI, Chen CY, Yang YR. Efficacy of Bobath versus orthopaedic approach on impairment and function at different motor recovery stages after stroke: a randomized controlled study. Clin
Rehabil. 2005; 19(2): 155-164.
DOI: https://doi.org/10.1191/0269215505cr850oa.
Pohl M, Werner C, Holzgraefe M, Kroczek G, Mehrholz J, Wingendorf I, et al. Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS). Clin Rehabil. 2007; 21(1): 17-27. DOI: https://doi.org/10.1177/0269215506071281.
Tung FL, Yang YR, Lee CC, Wang RY. Balance outcomes after additional sit-to-stand training in subjects with stroke: a randomized controlled trial. Clin Rehabil. 2010; 24(6): 533-542.
DOI: https://doi.org/10.1177/0269215509360751.
Brock K, Haase G, Rothacher G, Cotton S. Does physiotherapy based on the Bobath concept, in conjunction with a task practice, achieve greater improvement in walking ability in people with
stroke compared to physiotherapy focused on structured task practice alone?: a pilot randomized controlled. Clin Rehabil. 2011; 25(10): 903-912. DOI: https://doi.org/10.1177/0269215511406557.
Verhagen AP, Vet HCW De, Bie RA De, Alphons GH. The Delphi List: a Criteria List for quality assessment of randomized clinical trials for conducting systematic reviews developed by
delphi consensus. J Clin Epidemiol. 1998; 51(12):1235-1241. DOI: http://doi.org/10.1016/S0895-4356(98)00131-0.
Olivo SA, Macedo LG, Gadotti IC, Fuentes J, Stanton T, Magee DJ. Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther. 2008; 88(2): 156-175.
DOI: https://doi.org/10.2522/ptj.20070147.
Bovend’Eerdt TJ, Newman M, Barker K, Dawes H, Minelli C, Wade DT. The Effects of Stretching in spasticity: a systematic review. Arch Phys Med Rehabil. 2008; 89(7): 1395-1406.
DOI: https://doi.org/10.1016/j.apmr.2008.02.015.
Roberts J, Wilson K. Effect of stretching duration on active and passive range of motion in the lower extremity. BMJ Open Sport Exerc Med. 1999; 33(4): 259-263.
DOI: https://doi.org/10.1136/ bjsm.33.4.259.
Kollen BJ, Lennon S, Lyons B, Wheatley-Smith L, Scheper M, Buurke JH, et al. The effectiveness of the Bobath concept in stroke rehabilitation what is the evidence?. Stroke. 2009; 40(4): 89-97.
DOI:https://doi.org/10.1161/strokeaha.108.533828.
Bobath B. Concepto y Principios del Tratamiento. En: Hemiplejía del adulto: Evaluación y tratamiento. 3ed ed. Buenos Aires: Panamericana; 1999; 70-79.
Dickstein R, Hocherman S, Pillar T, Shaham R. Three Exercise Therapy Approaches. J Am Phys Ther Assoc. 1986; 66(8): 1233-1238. DOI: 10.1093/ptj/66.8.1233.
Voss D, Ionta M, Myers B. Facilitación neuromuscular propioceptiva. patrones y técnicas. 3ed ed. Madrid: Panamericana; 2004.
De Wit, Putman K, Dejaeger E, Baert I, Berman P, Bogaerts K. Use of time by stroke patients: a comparison of four European rehabilitation centers. Stroke. 2005; 36(9): 1977-1983.
DOI: https://doi.org/10.1161/01.str.0000177871.59003.e3.
Duncan PW, Zorowitz R, Bates B, Choi JY, Glasberg JJ, Graham GD, et al. Management of adult stroke rehabilitation care: a clinical practice guideline. Stroke. 2005; 36(9). e100-143. DOI: https://doi.
org/10.1161/01.str.0000177871.59003.e3.
Paolucci S, Antonucci G, Grasso MG, Morelli D, Troisi E, Cairo P, et al. Early versus delayed inpatient stroke rehabilitation: a matched comparison conducted in Italy. Arch Phys Med Rehabil. 2000; 81(6): 695-700. DOI: https://doi.org/10.1016/s0003-9993(00)90095-9.
Kwakkel G, Kollen BJ, Wagenaar RC. Therapy impact on functional recovery in stroke rehabilitation: a critical review of the literature. Physiotherapy. 1999;85(7): 377-391.
DOI: https://doi.org/10.1016/s0031-9406(05)67198-2.
McDowd J, Filion D, Pohl P, Richards L, Stiers W. Attentional abilities and functional outcomes following stroke. J Gerontol B Psychol Sci Soc Sci. 2003; 58: 45-53. DOI: https://doi.org/10.1093/
geronb/58.1.p45.
Selles RW, Li X, Lin F, Chung SG, Roth EJ, Zhang LQ. Feedback-controlled and programmed stretching of the ankle plantarflexors and dorsiflexors in stroke: effects of a 4-week intervention program.
Arch Phys Med Rehabil. 2005; 86(12): 2330-2336.
DOI: https://doi.org/10.1016/j.apmr.2005.07.305.
Smania N, Picelli A, Munari D, Geroin C, Ianes P, Waldner A, et al. Rehabilitation procedures in the management of spasticity. Eur J Phys Rehabil Med. 2012; 26: 423-438. PMID:20927008.
Gao F, Ren Y, Roth EJ, Harvey R, Zhang LQ. Effects of repeated ankle stretching on calf muscletendon and ankle biomechanical properties in stroke survivors. Clin Biomech. 2011; 26(5): 516-522. DOI:https://doi.org/10.1016/j.clinbiomech.2010.12.003.
Bressel E, Mcnair PJ. The Effect of prolonged static and cyclic stretching on ankle joint stiffness, torque relaxation, and gait in people with stroke. Phys Ther. 2002; 82: 880-887.
DOI: https://doi.org/10.1093/ptj/82.9.880.
Mauritz KH. Neurorehabilitation in spasticity. Postępy Psychiatr i Neurol 2004; 2(18): 41-47.
Robinson KL, McComas AJ, Belanger AY. Control of soleus motoneuron excitability during muscle stretch in man. J Neurol Neurosurg Psychiatry. 1982; 45(8): 699-704.
DOI: https://doi.org/10.1136/jnnp.45.8.699.
Lamy JC, Wargon I, Mazevet D, Ghanim Z, Pradat-Diehl P, Katz R. Impaired efficacy of spinal presynaptic mechanisms in spastic stroke patients. Brain. 2009; 132(3): 734-748.
DOI: https://doi.org/10.1093/brain/awn310.
Kohan AH, Abootalebi S, Khoshnevisan A, Rahgozar M. Comparison of modified ashworth scale and Hoffmann reflex in study of spasticity. Acta Med Iran. 2010; 48(3): 154-157. PMID:
Tsai KH, Yeh CY, Chang HY, Chen JJ. Effects of a single session of prolonged muscle stretch on spastic muscle of stroke patients. Proc Natl Sci Counc Repub China B. 2001; 25(2): 76-81. PMID:11370763.
Yeh CY, Chen JJJ, Tsai KH. Quantifying the effectiveness of the sustained muscle stretching treatments in stroke patients with ankle hypertonia. J Electromyogr Kinesiol. 2007;17(4): 453-61.
DOI:https://doi.org/10.1016/j.jelekin.2006.07.001.
Robichaud JA, Agostinucci J, Vander Linden DW. Effect of air-splint application on soleus muscle motoneuron reflex excitability in nondisabled subjects and subjects with cerebrovascular accidents.Phys Ther. 1992; 72(3): 176-185. DOI:https://doi.org/10.1093/ptj/72.3.176.
Annaswamy T, Mallempati S, Allison SC, Abraham LD. Measurement of plantarflexor spasticity in traumatic brain injury. Am J Phys Med Rehabil. 2007; 86(5): 404-411.
DOI: https://doi.org/10.1097/phm.0b013e31804a7d85.
Doussoulin-Sanhueza MA. Como se fundamenta la neurrorehabilitación desde el punto de vista de la neuroplasticidad. Arch Neurociencias. 2011; 16(4): 216-222.
Plow EB, Carey JR, Nudo RJ, Pascual-Leone A. Invasive cortical stimulation to promote recovery of function after stroke. Am Hear Assoc. 2008; 144(5): 724-732.
DOI: https://doi.org/10.1161/strokeaha.108.540823.
Selzer ME, Zorowitz RD. Designing prospective, randomized, multicenter clinical trials of physical rehabilitation treatment modalities. Neurorehabil Neural Repair. 2003; 17: 135-136. DOI: https://doi.org/10.1177/0888439003257318.
Lettinga A, Reynders K, Mulder T, Mol A. Pitfalls in effectiveness research: a comparative analysis of treatment goals and outcome measures in stroke rehabilitation. Clin Rehabil. 2002; 16: 174-181.
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