Thermography assessment of spastic lower limb in patients after cerebral stroke undergoing rehabilitation

Stroke contributes to disability in adulthood. The assessment of the degree of spasticity is one of the basic methods of patient examination after stroke and is used for monitoring rehabilitative outcomes; however, no optimal scale for the unambiguous assessment of spasticity exists. Our study aimed to assess the usefulness of thermography in measuring the effects of rehabilitation in stroke patients’ spastic hemiparesis. In this prospective, single-center study, 40 stroke patients with a mean age of 60.6 ± 5.5 years were enrolled. All suffered from hemiparesis. Surface temperature of the shank was assessed with infrared thermography; degree of independence with the Barthel Index; and muscle tone with the Modified Ashworth Scale. A comparison of temperature between the spastic and non-spastic posterior part of the shank was conducted. Temperature changes, severity of spasticity, and gait pattern were evaluated and compared at baseline and after 6 weeks of rehabilitation. All patients completed a rehabilitation program. The baseline temperature in the spastic extremity was significantly lower than in the normal extremity (mean temperature 28.93 °C vs 30.20 °C; p = 0.0001). After rehabilitation, the temperature in the spastic extremity increased significantly; however, the significant difference between the two extremities persisted (mean temperature 29.76 °C vs 30.54 °C; p = 0.0001). After rehabilitation, spasticity in affected extremity decreased significantly (p > 0.001). Additionally, an improvement in gait pattern was observed. We conclude that thermography proved to be useful in the assessment of rehabilitation effects in stroke patients with spastic hemiparesis; thus, it can be considered an additional tool for determining impaired muscle tone in patients with spasticity.

ANÁLISE DA FUNÇÃO MANUAL DE UMA CRIANÇA COM HEMIPARESIA ESPÁSTICA PRÉ E PÓS-TRATAMENTO FISIOTERAPÊUTICO: ESTUDO DE CASO

RESUMOA alteração da função manual é um dos sintomas mais incapacitantes da hemiparesia espástica resultante da Paralisia Cerebral. O indivíduo pode apresentar alterações neuromusculoesqueléticas na extremidade superior acometida, como aumento do tônus muscular, diminuição da força e prejuízos na motricidade fina. Com base nisso, o objetivo deste estudo foi avaliar os efeitos da Fisioterapia na função manual de uma criança com hemiparesia espástica. Pesquisa quase-experimental, do tipo estudo de caso, com análise comparativa antes e depois do tratamento. A amostra foi composta pelo paciente G.N., de 6 anos de idade e portador de hemiparesia espástica à direita. O protocolo de intervenção foi constituído de 12 sessões de Fisioterapia, com frequência semanal e duração de 50 minutos. A Fisioterapia baseou-se na Terapia de Contensão Induzida, no Conceito Neuroevolutivo Bobath e na Gameterapia. Para a análise antes e depois da intervenção, a escala Pediatric Motor Activity Log (PMAL) foi aplicada no primeiro e último dia de atendimento a fim de avaliar a frequência e a qualidade de movimento do membro superior acometido. Os resultados da PMAL mostraram um aumento da média da pontuação de frequência de movimento e na média da pontuação de qualidade de movimento. O presente estudo de caso evidenciou que a Fisioterapia resultou em uma maior funcionalidade do membro superior direito da criança e favoreceu aquisições de novas habilidades motoras. Além da diversidade de estímulos para o aprendizado motor, a contribuição familiar foi determinante para o sucesso do tratamento.Palavras-chave: Paralisia cerebral. Fisioterapia. Reabilitação. Extremidade superior.ABSTRACTHand function impairment is one of the most disabling symptoms of spastic hemiparesis resulting from Cerebral Palsy. Patients may present neuromusculoskeletal disorders on the affected upper extremity, such as increase of the muscle tone, decrease of strength and losses on fine motor skills. Based on that, the goal of this study is to evaluate the effects of Physical Therapy on the hand function of a child with spastic hemiparesis. Quasi-experimental design, case-study research, with comparative analysis before and after the treatment. The sample was composed of a six-year-old patient with spastic hemiparesis on the right side. The intervention protocol was constituted of twelve Physical Therapy sessions, performed weekly and with 50 minutes duration. The Physical Therapy was based on the Constraint-induced Movement Therapy, Bobath Concept and Game Therapy. In order to measure outcomes before and after the intervention, the Pediatric Motor Activity Log (PMAL) scale was applied on the first and last session for assessment of the frequency and quality of movement on the affected upper limb. The PMAL‘s results showed an increase in the average movement frequency score and in the average movement quality score. This case study showed that Physical Therapy resulted in greater upper limb functionality to the child and favored the acquisition of new motor skills. Besides the diversity of stimuli for motor learning, the family contribution was determinant for the success of the treatment.Keywords: Cerebral palsy. Physical therapy specialty. Rehabilitation. Upper extremity.