Intervenção precoce na reabilitação pós-AVC: avaliação da recuperação funcional e qualidade de vida
DOI:
https://doi.org/10.18378/rebes.v14i3.10943Resumo
O acidente vascular cerebral (AVC) é uma condição neurológica grave causada por isquemia ou hemorragia nas artérias cerebrais, levando a deficiências motoras e cognitivas. O AVC é uma das principais causas de mortalidade e incapacidade global, afetando cerca de 16 milhões de pessoas anualmente. A idade é um fator crucial, com a maioria dos pacientes tendo mais de 65 anos. Embora as taxas de mortalidade e prevalência tenham diminuído devido a avanços no tratamento, os números absolutos de mortes e anos de vida perdidos continuam a crescer. A reabilitação precoce é essencial para melhorar a recuperação funcional dos pacientes, e este artigo tem como objetivo investigar o impacto de estratégias de intervenção precoce na recuperação pós-AVC. Trata-se de uma revisão bibliográfica qualitativa descritiva, com busca sistemática em bases de dados acadêmicas (PubMed, Scopus, Google Scholar) usando descritores como “intervenção precoce pós-AVC”. O estudo, realizado em setembro de 2024, selecionou artigos originais e gratuitos em português ou inglês, excluindo trabalhos incompletos ou repetidos. O período pós-AVC é dividido em fases: hiperaguda (primeiras 24h), aguda (primeiros 7 dias), subaguda inicial (primeiros 3 meses), subaguda tardia (meses 4-6) e crônica (a partir de 6 meses). A recuperação depende fortemente do tempo, com os processos de plasticidade cerebral iniciando rapidamente após o AVC e variando em eficácia nas diferentes fases. Melhorias mais significativas ocorrem nas primeiras semanas, atingindo um platô após três meses, com possível recuperação adicional na fase crônica com intervenção contínua. A mobilização precoce tem papel controverso na fase aguda, e a fisioterapia, terapia ocupacional e terapia da fala são essenciais para a recuperação funcional e qualidade de vida. A abordagem multidisciplinar e personalizada, combinada com medicação para controlar sintomas e prevenir complicações, é crucial para otimizar os resultados. Recomenda-se continuar explorando e aprimorando práticas de reabilitação para maximizar a recuperação dos pacientes pós-AVC.
Downloads
Referências
BAMFORD, John; SPILLER, John; LAMONT, James; KITCHIN, Raymond; BIRKS, Jane. The frequency, causes and timing of death within 30 days of a first stroke: the Oxfordshire Community Stroke Project. Journal of Neurology, Neurosurgery & Psychiatry, v. 53, n. 10, p. 824-829, 1990.
BERNHARDT, J. et al. Agreed definitions and shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce. International Journal of Stroke, v. 12, n. 5, p. 444–450, 2017.
BOTTO, Gianluca et al. Unmet clinical needs in elderly patients receiving direct Oral anticoagulants for stroke prevention in non-valvular atrial fibrillation. Advances in therapy, v. 38, n. 6, p. 2891-2907, 2021.
CARMICHAEL, S. THOMAS et al. New patterns of intracortical projections after focal cortical stroke. Neurobiology of disease, v. 8, n. 5, p. 910-922, 2001.
CECCHI, Francesca. Does occupational therapy improve activities of daily living and/or cognitive abilities in stroke patients with cognitive impairment? A Cochrane Review summary with commentary. NeuroRehabilitation, n. Preprint, p. 1-5, 2023.
CHOWDHURY, Rajib Nayan et al. Pattern of neurological disease seen among patients admitted in tertiary care hospital. BMC research notes, v. 7, p. 1-5, 2014.
CRAMER, Steven C. Repairing the human brain after stroke: I. Mechanisms of spontaneous recovery. Annals of neurology, v. 63, n. 3, p. 272-287, 2008.
DOUGLAS, M. R. et al. The inpatient neurology consultation service: value and cost. Clinical Medicine, v. 11, n. 3, p. 215-217, 2011.
FEIGIN, Valery L. et al. Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology, v. 18, n. 5, p. 459-480, 2019.
FENG, Fen et al. Effects of Tai Chi Yunshou on upper-limb function and balance in stroke survivors: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice, v. 51, p. 101741, 2023.
FOERCH, Christian et al. The projected burden of stroke in the German federal state of Hesse up to the year 2050. Deutsches Ärzteblatt International, v. 105, n. 26, p. 467, 2008.
HEART, N.; LUNG; INSTITUTE, B. What Is a Stroke?. 2023. Disponível em: https://www.nhlbi.nih.gov/health-topics/stroke. Acesso em: 9 set. 2024.
HOLSBEEKE, Laura et al. Capacity, capability, and performance: different constructs or three of a kind?. Archives of physical medicine and rehabilitation, v. 90, n. 5, p. 849-855, 2009.
HOWARD, George; GOFF, David C. Population shifts and the future of stroke: forecasts of the future burden of stroke. Annals of the New York Academy of Sciences, v. 1268, n. 1, p. 14-20, 2012.
JOHNSON, Walter et al. Stroke: a global response is needed. Bulletin of the World Health Organization, v. 94, n. 9, p. 634, 2016.
KAYOLA, Grace et al. Stroke rehabilitation in low-and middle-income countries: challenges and opportunities. American journal of physical medicine & rehabilitation, v. 102, n. 2S, p. S24-S32, 2023.
KERNAN, Walter N. et al. Primary care of adult patients after stroke: a scientific statement from the American Heart Association/American Stroke Association. Stroke, v. 52, n. 9, p. e558-e571, 2021.
KINOSHITA, Shoji et al. Utility of the revised version of the ability for basic movement scale in predicting ambulation during rehabilitation in poststroke patients. Journal of Stroke and Cerebrovascular Diseases, v. 26, n. 8, p. 1663-1669, 2017.
KITAGAWA, Kazuo. CREB and cAMP response element‐mediated gene expression in the ischemic brain. The FEBS journal, v. 274, n. 13, p. 3210-3217, 2007.
KWAKKEL, Gert et al. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke, v. 34, n. 9, p. 2181-2186, 2003.
LIU, Ning et al. Randomized controlled trial of early rehabilitation after intracerebral hemorrhage stroke: difference in outcomes within 6 months of stroke. Stroke, v. 45, n. 12, p. 3502-3507, 2014.
MARINHO-BUZELLI, Andresa R. et al. A qualitative pilot study exploring clients’ and health-care professionals’ experiences with aquatic therapy post-stroke in Ontario, Canada. Topics in Stroke Rehabilitation, v. 31, n. 1, p. 86-96, 2024.
MARZOUQAH, Reeman et al. The role of oral and pharyngeal motor exercises in post-stroke recovery: A scoping review. Clinical rehabilitation, v. 37, n. 5, p. 620-635, 2023.
NISHIMURA, Yukio et al. Time-dependent central compensatory mechanisms of finger dexterity after spinal cord injury. Science, v. 318, n. 5853, p. 1150-1155, 2007.
O’BRIEN, Suzanne R. et al. Physical therapist clinical reasoning in home care for walking assistive device prescription: A description of practice. Physiotherapy theory and practice, v. 39, n. 1, p. 80-88, 2023.
PERRY, Jacquelin et al. Classification of walking handicap in the stroke population. Stroke, v. 26, n. 6, p. 982-989, 1995.
PICCOLO, Adriana et al. Music therapy in global aphasia: a case report. Medicines, v. 10, n. 2, p. 16, 2023.
RICHARDS, Lorie G.; CRAMER, Steven C. Therapies targeting stroke recovery. Stroke, v. 54, n. 1, p. 265-269, 2023.
SCHROETER, M. et al. Struktur der neurologischen Kliniken in Deutschland: Ergebnisse der 13. Erhebung der Deutschen Gesellschaft für Neurologie. DGNeurologie. 2019.
SHEN, Jie et al. Effects of virtual reality–based exercise on balance in patients with stroke: a systematic review and meta-analysis. American Journal of Physical Medicine & Rehabilitation, v. 102, n. 4, p. 316-322, 2023.
SIRE, Alessandro et al. Buccal hemineglect: Is it useful to evaluate the differences between the two halves of the oral cavity for the multidisciplinary rehabilitative management of right brain stroke survivors? A cross-sectional study. Topics in Stroke Rehabilitation, v. 27, n. 3, p. 208-214, 2020.
SKARIN, Monica et al. ‘Better wear out sheets than shoes’: a survey of 202 stroke professionals' early mobilisation practices and concerns. International Journal of Stroke, v. 6, n. 1, p. 10-15, 2011.
STIENS, Maria et al. Occupational Therapy Interventions for Improving Health-Related Quality of Life in Adults Post-Stroke: A Rapid Systematic Review. 2021.
TRIANTIS, Elyse; LIU, Karen PY. Activities of daily living interventions on activity performance of inpatients post-stroke: A systematic review and meta-analysis. British Journal of Occupational Therapy, p. 03080226241255021, 2024.
WHO. World Health Organization. International Classification of Functioning, Disability, and Health: Children & Youth Version: ICF-CY. World Health Organization, 2007. Disponível em: https://iris.who.int/bitstream/handle/10665/43737/;jsessionid=022529811DB7352DCDD6F6B6D9BD3161?sequence=1. Acesso em: 09 set. 2024.
XU, Tao et al. Efficacy and safety of very early mobilization in patients with acute stroke: a systematic review and meta-analysis. Scientific Reports, v. 7, n. 1, p. 6550, 2017.
YAGI, Maiko et al. Impact of rehabilitation on outcomes in patients with ischemic stroke: a nationwide retrospective cohort study in Japan. Stroke, v. 48, n. 3, p. 740-746, 2017.
ZHANG, Wen Wen et al. Stroke rehabilitation in China: a systematic review and meta-analysis. International Journal of Stroke, v. 9, n. 4, p. 494-502, 2014.
Downloads
Publicado
Versões
- 2024-09-09 (2)
- 2024-09-09 (1)
Como Citar
Edição
Seção
Licença
Copyright (c) 2024 Gabriel Dávila Conte, Filippo Resende Carlétti, Enrico Resende Carletti, Olivia Duarte de Oliveira, Maria Isadora Fernandes Lima, Mariana de Arruda Frazão, Ciro Quinan Frazão, Joilton Aureliano de Lima Filho
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Termo de cess
1.png)
milenanunes@fiponline.edu.br 
+55 83 988784633 (Milena Sousa)