Produção Nacional
Revisado por pares
Motor Neuroprosthesis for Promoting Recovery of Function After Stroke
2020; Lippincott Williams & Wilkins; Volume: 51; Issue: 7 Linguagem: Inglês
10.1161/strokeaha.120.029235
ISSN1524-4628
AutoresLuciana de Andrade Mendes, Íllia Nadinne Dantas Florentino Lima, Túlio Oliveira de Souza, George C. do Nascimento, Vanessa Resqueti, Guilherme Fregonezi,
Tópico(s)Botulinum Toxin and Related Neurological Disorders
ResumoHomeStrokeVol. 51, No. 7Motor Neuroprosthesis for Promoting Recovery of Function After Stroke Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessReview ArticlePDF/EPUBMotor Neuroprosthesis for Promoting Recovery of Function After Stroke Luciana A. Mendes, MSc, Íllia N.D.F. Lima, PhD, Túlio O. Souza, PhD, George C. do Nascimento, PhD, Vanessa R. Resqueti, PhD and Guilherme A.F. Fregonezi, PhD Luciana A. MendesLuciana A. Mendes Correspondence to: Luciana A. Mendes, PT, MSc, Department of Biomedical Engineering, Federal University of Rio Grande do Norte, Ave Senador Salgado Filho, 3000 Natal, Rio Grande do Norte 59078, Brazil. Email E-mail Address: [email protected] https://orcid.org/0000-0002-7727-7011 PneumoCardioVascular Laboratory, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil (L.A.M., V.R.R., G.A.F.F.). Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil (L.A.M., V.R.R., G.A.F.F.). Departamento de Engenharia Biomédica, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil (L.A.M., G.C.d.N.). , Íllia N.D.F. LimaÍllia N.D.F. Lima Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte (UFRN), Santa Cruz, RN, Brazil (I.N.D.F.L.). , Túlio O. SouzaTúlio O. Souza Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil (T.O.S., V.R.R., G.A.F.F.). , George C. do NascimentoGeorge C. do Nascimento Departamento de Engenharia Biomédica, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil (L.A.M., G.C.d.N.). , Vanessa R. ResquetiVanessa R. Resqueti PneumoCardioVascular Laboratory, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil (L.A.M., V.R.R., G.A.F.F.). Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil (L.A.M., V.R.R., G.A.F.F.). Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil (T.O.S., V.R.R., G.A.F.F.). and Guilherme A.F. FregoneziGuilherme A.F. Fregonezi PneumoCardioVascular Laboratory, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil (L.A.M., V.R.R., G.A.F.F.). Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil (L.A.M., V.R.R., G.A.F.F.). Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil (T.O.S., V.R.R., G.A.F.F.). Originally published5 Jun 2020https://doi.org/10.1161/STROKEAHA.120.029235Stroke. 2020;51:e119–e120Motor neuroprosthesis (MN) involves electrical stimulation of neural structures to increase the activities and participation of people with stroke in the natural environment in which people live, as an orthosis.ObjectivesOur systematic review assessed the effects of MN for improving independence in activities of daily living, activities involving limbs, health-related quality of life, exercise capacity, balance, and adverse events in people after stroke.MethodsWe searched the Cochrane Stroke Group Trials Register (searched August 19, 2019), the Cochrane Central Register of Controlled Trials (August 2019), MEDLINE (1946 to August 16, 2019), Embase (1980 to August 19, 2019), additional databases (searched August 19, 2019), trial registries (searched August 21, 2019), and websites (searched August 19, 2019) to identify relevant published, unpublished, and ongoing trials.Two review authors independently selected trials for inclusion, assessed methodologic quality, and extracted the data.The primary outcomes were independence in activities of daily living and activities involving limbs. The secondary outcomes were participation scales of health-related quality of life, exercise capacity, balance, and adverse events. We included randomized controlled trials and randomized controlled crossover trials comparing MN for improving activities and participation versus another assistive technology device, or MN turned off, or no treatment.ResultsWe included 4 studies involving 831 participants. All studies were of MN versus another assistive device. No studies reported outcomes related to independence in activities of daily living. MN was no more beneficial than another assistive device on walking speed (mean difference [MD], 0.00 m/s [95% CI, −0.05 to 0.05]; P=0.97; Figure), Timed Up and Go (MD, 0.51 s [95% CI, −4.41 to 5.43]; P=0.84), modified Emory Functional Ambulation Profile (MD, 14.77 s [95% CI, −12.52 to 42.06]; P=0.29), health-related quality of life (standardized MD, 0.26 [95% CI, −0.22 to 0.74]; P=0.28), exercise capacity (MD, −9.03 m [95% CI, −26.87 to 8.81]; P=0.32), and balance (MD, −0.34 [95% CI, −1.96 to 1.28]; P=0.68). Although MN did not increase the number of serious adverse events related to intervention (risk ratio, 0.35 [95% CI, 0.04–3.33]; P=0.36), the use of MN in people after stroke may increase the risk of participants dropping out during the intervention (risk ratio, 1.48 [95% CI, 1.11–1.97]; P=0.007).ConclusionsOur findings indicate that in home or community context, the use of lower limb MN is not any different to another assistive technology device for improving activities involving limbs measured by walking speed, Timed Up and Go and modified Emory Functional Ambulation Profile; health-related quality of life; exercise capacity; and balance. MN may result in a higher number of dropouts during intervention period.Further randomized trials are needed and should be conducted using a larger sample, preferably with blinded outcome assessment. Also, there is a need to assess participant compliance or satisfaction to understand the cause of increased risk of MN dropouts and to explore outcomes related to activity and participation during all-day use of MN period separately from the conditioning protocols period.Download figureDownload PowerPointFigure. Forest plot of activities involving limbs measured by walking speed between 6 and 12 mo of device use.AcknowledgmentsThis article is based on a Cochrane Review published in The Cochrane Library 2020, Issue 1 (see www.thecochranelibrary for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.1Sources of FundingNone.DisclosuresNone.FootnotesFor Sources of Funding and Disclosures, see page e120.Correspondence to: Luciana A. Mendes, PT, MSc, Department of Biomedical Engineering, Federal University of Rio Grande do Norte, Ave Senador Salgado Filho, 3000 Natal, Rio Grande do Norte 59078, Brazil. Email mendes.luciana.[email protected]comReferences1. Mendes LA, Lima INDF, Souza T, do Nascimento GC, Resqueti VR, Fregonezi GAF. Motor neuroprosthesis for promoting recovery of function after stroke.Cochrane Database Syst Rev. 2020; 1:CD012991. doi: 10.1002/14651858.CD012991.pub2Google Scholar Previous Back to top Next FiguresReferencesRelatedDetails July 2020Vol 51, Issue 7Article InformationMetrics Download: 577 © 2020 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.120.029235PMID: 32498659 Originally publishedJune 5, 2020 Keywordsbracesmeta-analysiselectric stimulationquality of lifestrokePDF download SubjectsTreatmentMeta AnalysisCerebrovascular Disease/Stroke
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