Neuroestimulação no tratamento do acidente vascular cerebral: ensaio clínico, duplo-cego, placebo-controlado

• Ano de defesa: 2014
• Autor(a) principal: Andrade, Suellen Mary Marinho dos Santos
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal da Paraíba; Brasil; Psicologia Social; Programa de Pós-Graduação em Psicologia Social; UFPB
• Palavras-chave em Português: Acidente cerebrovascular; Stroke; Estimulação elétrica; Ensaio clínico controlado randomizado; Eletrical stimulation; Randomized controlled clinical trial; CIENCIAS HUMANAS::PSICOLOGIA
• Link de acesso: https://repositorio.ufpb.br/jspui/handle/tede/7511

Traditional treatment after stroke includes medications and physical rehabilitation, which is generally composed of non-systematic protocols, which hinders its replicability. The transcranial direct current stimulation (tDCS) associated with a standardized physical therapy may represent an effective therapeutic alternative for these patients. The objective of this study was to analyze the effects of tDCS, combined with Constraint-induced movement therapy (CIMT) in patients in sub-acute stage of stroke. A clinical trial, placebo-controlled, double blind, randomized, was designed involving 40 patients with a diagnosis of ischemic stroke, unilateral, non-recurring. Participants were randomly assigned to 02 groups, with active stimulation and the other with placebo current. All received systematic physical therapy, based on the principles of CIMT. The intervention was applied for 10 consecutive days with current 2mA, with the anode positioned over the primary motor cortex (M1), ipsilateral to the lesion, and the cathode over the contralateral supraorbital region. Patients underwent three functional evaluations: baseline (T0), week 2 (T1) and week 4 (T2). Neuropsychological tests and safety tests were performed at T0 and T2. Regarding the total participants, 86% (n = 35) completed the protocol. The dropout was higher in the active tDCS compared to placebo, but this relationship was not statistically significant (p > 0.05). The clinical characteristics and socio demographic no differences between groups were observed. As for the primary endpoint, showed that performance in Barthel Index differ between groups (F1,38 = 9.46; p = 0.04; η2= 0.19) and over time (F2,38 =166.29; p = 0.00; η2 = 0.81), with group x time interaction (F2,38 = 24.33; p = 0.00; η2= 0.39), where participants who received active stimulation performed better than those treated with sham tDCS. Regarding secondary outcomes, spasticity, upper limb function and use of paretic limb, the same pattern was observed in relation to functional independence, where patients who receive active stimulation achieved higher scores. Regarding safety, no serious adverse effects and no deleterious effects were observed for both groups during the treatment and follow-up. Thus, the data demonstrate the efficacy and safety of active tDCS, combined with physiotherapy, in rehabilitation after stroke.