Estudo comparativo entre um protocolo com realidade virtual não imersiva e a cinesioterapia no equilíbrio postural em indivíduos com acidente vascular cerebral

Abstract

Introduction: Stroke is the main cause of disability in adults, leading to functional changes, such as balance deficit and difficulty in performing activities of daily living. The sequelae result from plastic changes in the neural tissue, as a result of decreased excitability and non-use of the affected limbs after the injury, culminating in a reduction in the cortical representation of these areas. In the field of rehabilitation, Virtual Reality (VR) has proven to be a great ally in the recovery of these patients. Objective: To compare the effects of a non-immersive virtual reality protocol with a kinesiotherapy protocol, both with the same dosage, evolution and goals, on the postural balance of individuals with chronic stroke. Methodology: This is a comparative study with 7 individuals with a clinical diagnosis of stroke. The individuals were evaluated before and after the intervention through a sociodemographic form and then clinical assessment was performed: Mini Mental State Examination - MMSE, Modified Ashworth Scale, Functional Ambulatory Category - FAC, (National Institute Health Stroke Scale – NIHSS, Stroke Specific Quality of Life Scale – (SS-QOL), Functional Independence Measure – FIM, Intrinsic Motivation Inventory –IMI, Berg Balance Scale –BBS, Functional Range Test- FRT, Timed Up and Go Test (TUG); 6m Walk Test - 6mWT, and Center of pressure variables by Force Platform- FP. Participants were divided into two groups: kinesiotherapy group (KG, n=4) which performed lower limb (LL) strengthening and kinesiotherapy focusing on balance with sensorimotor demand similar to VR exercises and the VR group (VRG, n=3) who performed LL strengthening and a VR protocol based on postural balance. There were 2 sessions per week, for 8 weeks, totaling 16 sessions. Paired t-test was performed for intragroup analysis and ttest for intergroup comparison, analyzing the differences between pre- and postintervention (delta) values for each group. Results: Both groups improved in all analyzed outcomes. In the intragroup analysis, there was significance in the KG for the BBS (p = 0.006); SS-QOL (p= 0,035); total displacement of the center of pressure in the single leg stance test with eyes open on paretic limb (p = 0.017); mean velocity in the unipodal support test with eyes open on paretic limb (p = 0.007) and unipodal eyes closed on the healthy limb (p = 0.047); and in the GRV for the BBS (p = 0.026), MIF (p = 0.008) and total displacement of the center of pressure in the unipodal support test with eyes open on a healthy limb (p = 0.035). In the intergroup analysis, there was a statistically significant difference for BBS (p = 0.033), quality of life (p = 0.021), IMI pressure (p = 0.025) and unipodal support with eyes open on a paretic limb (p = 0.044) in favor of the KG. Conclusion: It was observed that the application of the KG and VRG intervention protocols were beneficial and led to improvements in the analyzed outcomes, mainly in the control of postural balance. However, due to limitations in terms of sample size and number of sessions, it is suggested that studies be carried out with a more robust population and a longer total duration of therapy.