Electroestimulación en el tratamiento de la mano hemipléjica espástica después de un ictus: estudio aleatorizado

Sentandreu‐Mañó, Trinidad; Terrádez, José Ricardo Salom; Tomás, José M.; Moral, Juan Carlos Meléndez; Fernández, Trinidad de la Fuente

doi:10.1016/j.medcli.2010.10.024

Cited by 7 publications

(6 citation statements)

References 27 publications

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“…For the purpose of the present review, electrostimulation was divided into (a) neuromuscular stimulation (NMS); (b) electromyography-triggered neuromuscular stimulation (EMG-NMS); and (c) transcutaneous electrical nerve stimulation (TENS). Electrostimulation of the paretic arm was investigated in 49 RCTs (N = 1521, PEDro score range 3 [376]–[379] to 8 [380]) [200], [267], [271], [321], [328], [376]–[423], including patients in the early rehabilitation phase [200], [321], [376], [380], [381], [383], [384], [386], [387], [389]–[392], [395], [402], [404], [405], [407], [413], [415]–[417], [419], [420], [422], late rehabilitation phase [382], [398]–[400], [406], [418], or chronic phase [267], [271], [328], [377]–[379], [393], [394], [396], [397], [401], [403], [408]–[412], [414], [421], [423]. The electrostimulation was not applied when outcomes were measured.…”

Section: Resultsmentioning

confidence: 99%

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What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis

et al. 2014

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BackgroundPhysical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT.Methods and FindingsRandomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed. Differences between phases poststroke were explored in subgroup analyses. A best evidence synthesis was performed for neurological treatment approaches. The search yielded 467 RCTs (N = 25373; median PEDro score 6 [IQR 5–7]), identifying 53 interventions. No adverse events were reported. Strong evidence was found for significant positive effects of 13 interventions related to gait, 11 interventions related to arm-hand activities, 1 intervention for ADL, and 3 interventions for physical fitness. Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03–0.70; I2 = 0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84–4.11; I2 = 77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02–0.39; I2 = 6%) for motor function of the paretic arm to 0.61 (95%CI 0.41–0.82; I2 = 41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences with respect to timing poststroke for 10 interventions. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing.ConclusionsThere is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases poststroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given.

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Section: Resultsmentioning

confidence: 99%

“…NMS of the paretic arm was investigated in 22 RCTs (N = 894) [376], [380], [381], [383]–[386], [389]–[392], [396], [398], [400], [402], [404], [406], [407], [410], [417]–[421].…”

Section: Resultsmentioning

confidence: 99%

What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis

et al. 2014

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“…Tras el ictus, se produce un déficit neurológico focal de inicio brusco (Blanco González et al, 2011) que puede acabar provocando una hemiparesia (García Carrasco & Aboitiz Cantalapiedra, 2016). Esta puede cursar con alteraciones motoras, cognitivas y sensitivas, afectación en el rango articular, alteraciones en el tono muscular, en la integración sensorial, contracturas, dolor, infecciones de vejiga, pérdida de la capacidad cardiovascular y cambios en los tejidos debidos a una menor actividad muscular (Blanco González et al, 2011;Domínguez Ferraz & Grau Pellicer, 2011;García Carrasco & Aboitiz Cantalapiedra, 2016;Park et al, 2014;Popović, 2014;Sentandreu Mañó et al, 2011). En el caso del miembro superior (MS), se puede dar lugar a la mano en garra, y a una pérdida de la funcionalidad de esta extremidad, por lo que las actividades de la vida diaria (AVD) del paciente se pueden ver afectadas (Park et al, 2014;Sentandreu Mañó et al, 2011).…”

Section: Materials Y Métodounclassified

“…Algunos de sus factores de riesgo más importantes son la hipertensión arterial, los antecedentes de enfermedad cardíaca, el tabaquismo, la dislipemia, el ACV previo, la diabetes mellitus y la fibrilación auricular (Castro-Jiménez, 2022;Insaurralde et al, 2016). Además, la incidencia del ictus aumenta con la edad, afectando sobre todo a personas mayores de 65 años (Sentandreu Mañó et al, 2011).…”

Section: Introductionunclassified

“…En función de su naturaleza, el ictus puede ser de tipo isquémico, debido a una falta del aporte sanguíneo el uso de la realidad virtual, la robótica, la evocación mental y la electroestimulación (Campo-Prieto et al, 2020;García Carrasco & Aboitiz Cantalapiedra, 2016;Hara, 2015;Mollinedo Cardalda et al, 2022;Sentandreu Mañó et al, 2011). Esta última técnica, puede suponer una mejora en la neuroplasticidad durante la rehabilitación posterior al ictus, ya que, aunque estos efectos siguen en investigación, se cree que pueden ocasionar cambios en la actividad sináptica, en la expresión de los genes, además de un aumento de los niveles de neurotransmisores, receptores y neurotrofinas (Hara, 2015).…”

Section: Introductionunclassified

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Electroestimulación funcional para miembros superiores tras el accidente cerebrovascular: una revisión sistemática (Functional electrostimulation for upper limbs after stroke: a systematic review)

Niño

Pedro

Cardalda

et al. 2022

Retos

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Introducción: el accidente cerebrovascular o ictus es un trastorno circulatorio cerebral cuya incidencia en España es de 186,9 casos/100.000 habitantes cada año. El ictus provoca un déficit neurológico focal de inicio brusco que puede provocar una hemiparesia con alteraciones motoras, cognitivas y sensitivas, entre otras. Dentro de las técnicas de fisioterapia empleadas, se encuentra la electroestimulación funcional (FES). Objetivo: analizar la evidencia científica sobre los efectos de la electroestimulación funcional en los miembros superiores tras el ictus. Método: se realizó una búsqueda bibliográfica en las bases de datos PubMed, Medline y Cinahl empleando los términos del Medical Subject Headings «Stroke», «Electric Stimulation» y «Upper Extremity» y la palabra clave «Electrical Stimulation, Functional». Resultados: tras aplicar los criterios de inclusión y de exclusión se obtienen 14 estudios que aplican la FES en el miembro superior. La mayoría de los estudios centran su atención en la mejora de la fuerza, del rango de movimiento, de la espasticidad y del tono muscular, del grado de discapacidad, del desarrollo de las actividades de la vida diaria, del dolor y de la escala Fugl Meyer Assessment for Upper Limbs (FMA-UL). Conclusión: la FES parece conseguir beneficios frente a la rehabilitación convencional especialmente en los resultados de la escala FMA-UL. Con relación al resto de variables, aunque parecen observarse algunos beneficios, se necesitan más investigaciones con mayor calidad metodológica y con criterios comunes de medición, tanto en una fase temprana como en una crónica tras el ictus para poder establecer una tendencia de respuesta. Palabras clave: Electroestimulación funcional; Miembros superiores; Accidente cerebrovascular; Modalidades de fisioterapia; Pacientes. Abstract. Introduction: a cerebrovascular accident or stroke is a cerebral circulatory disorder whose incidence in Spain is 186.9 cases/100,000 inhabitants each year. Stroke causes a sudden-onset focal neurological deficit that can cause hemiparesis with motor, cognitive and sensory alterations, among others. Functional electrostimulation (FES) is one of the physiotherapy techniques used. Objective: to analyse the scientific evidence on the effects of functional electrostimulation in the upper limbs after stroke. Methods: a bibliographic search was carried out in the PubMed, Medline and Cinahl databases using the Medical Subject Headings terms «Stroke», «Electric Stimulation» and «Upper Extremity» and the keyword «Electrical Stimulation, Functional». Results: after applying the inclusion and exclusion criteria, 14 studies were obtained that applied the FES in the upper limb. Most studies focus on improving strength, range of motion, spasticity and muscle tone, the degree of disability, the development of activities of daily living, pain and the Fugl Meyer Assessment for Upper Limbs scale (FMA-UL). Conclusion: FES seems to achieve benefits compared to conventional rehabilitation, especially in the results of the FMA-UL scale. Regarding the rest of the variables, although some benefits seem to be observed, more research is needed with higher methodological quality and with common measurement criteria, both in an early phase and in a chronic phase after the stroke to establish a response trend. Keywords: Functional electrostimulation; Upper limbs; Stroke; Physical Therapy Modalities; Patients.

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Assistive technologies, including orthotic devices, for the management of contractures in adults after a stroke

Mohammed Meeran,

Durairaj,

Sekaran

et al. 2024

Cochrane Database of Systematic Reviews

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Electroestimulación en el tratamiento de la mano hemipléjica espástica después de un ictus: estudio aleatorizado

Cited by 7 publications

References 27 publications

What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis

What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis

Electroestimulación funcional para miembros superiores tras el accidente cerebrovascular: una revisión sistemática (Functional electrostimulation for upper limbs after stroke: a systematic review)

Assistive technologies, including orthotic devices, for the management of contractures in adults after a stroke

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