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Contributo para o Desenvolvimento de um Programa de Exercícios Escápulo-Torácicos para Utentes com Disfunções do Complexo Articular do Ombro, com auxílio de biofeedback cinemático
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Advisor(s)
Abstract(s)
Enquadramento: As disfunções do complexo articular do ombro, apresentam uma elevada incidência e prevalência, e o seu impacto na qualidade de vida do utente, torna relevante a procura pela melhor estratégia de intervenção que responda às suas necessidades. As patologias músculo-esqueléticas do ombro têm sido associadas à discinésia escapular, que consiste numa alteração da posição inicial da omoplata e do seu movimento durante os movimentos do membro superior. Os exercícios focados na estabilidade dinâmica da escápulo-torácica permitem ao sistema nervoso central readquirir padrões de movimento que não coloquem em risco as estruturas do complexo articular do ombro e que estão alterados na presença de disfunção. O biofeedback cinemático tridimensional tem-se demonstrado efetivo no reconhecimento da zona neutra e na melhoria da qualidade de execução dos exercícios.
Metodologia: O presente estudo de natureza metodológica, consistiu num contributo para o desenvolvimento de um programa de exercícios escápulo-torácicos para a intervenção em fisioterapia direccionado para utentes com disfunções no complexo articular do ombro (DCAO). Este estudo envolveu uma pesquisa bibliográfica em distintas bases de dados internacionais eletrónicas de forma a reunir e sintetizar a evidência existente e foi desenvolvido em 4 fases interligadas: análise crítica da efectividade de intervenções dirigidas a utentes com DCAO; descrição dos modelos e teorias, nos quais a fisioterapia se pode alicerçar para estruturar um programa de intervenção dirigido a utentes com DCAO; identificação e análise crítica de ferramentas relacionadas com movimento humano para informação de retorno e do seu enquadramento no processo de reabilitação; e por fim, o desenho e descrição detalhada de um programa de exercícios escápulo-torácicos dirigidos a utentes com DCAO com base no resultado das três fases anteriores.
Resultados: Desenvolveu-se um programa de exercícios escápulo-torácicos baseado em três estadios segundo um modelo de reaprendizagem motora e estabilidade dinâmica, utilizando exercícios e estratégias descritas como mais efetivos para as disfunções do ombro, recorrendo ao uso de biofeedback cinemático tridimensional. O programa de exercícios realizado visa diminuir a dor, restaurar a função e promover corretos padrões cinemáticos, levando à adoção de apropriadas estratégias de movimento por parte do utente.
Conclusão: Foi realizado o primeiro passo para o desenvolvimento de um programa de exercícios escapulo-torácicos que visa responder às necessidades de utentes com disfunção do complexo articular do ombro, contudo novos estudos são importantes para testar quanto à sua viabilidade, avaliar e implementar este programa de forma a poder verificar a sua efetividade e generalizar resultados à população.
Abstract: Introduction: The shoulder disorders have a high incidence and prevalence and its impact on patients’ life quality, makes relevant the search for the best intervention strategy in response to their needs. Musculoskeletal disorders of the shoulder have been associated with scapular dyskinesis, which is an alteration on resting position or dynamic motion of the scapula. The exercises for scapulothoracic dynamic stability allow the central nervous system regain movement patterns that do not compromise the shoulder joint structures and that are altered in the presence of dysfunction. The three-dimensional kinematic biofeedback has been shown to be an effective tool for recognizing the neutral zone and improving the quality of the scapula-focused exercises execution. Methodology: This methodological study aims to contribute to the development of a physiotheraphy scapula-focused exercise program for patients with shoulder dysfunction. This study involved a literature search in different international electronic databases in order to gather and synthesize existing evidence, and its development step involved four interlinked phases: critical analysis of the effectiveness ofphysiotherapy interventions for patients with shoulder dysfunction; description of the models and theories, in which physical therapy can be based to structure an intervention program for patients with shoulder dysfunction; identification and critical analysis of tools related to human movement used as feedback in the rehabilitation process; and, finally, development and detailed description of a physiotheraphy scapula-focused exercise program for patients with shoulder dysfunction, based on the result of the three previous stages. Results: A scapula-focused exercise program was developed based on three stages in accordance with a motor relearning model and dynamic stability using exercises and strategies described as more effective for the shoulder dysfunction, such as the use of three-dimensional kinematic biofeedback. This exercise program aims to reduce pain, restore function and promote correct kinematic patterns, leading to the adoption of appropriate movement strategies by the patient. Conclusion: This study represents the first step towards the development of a scapula-focused exercise program that aims to respond to the needs of patients with shoulder dysfunction. However further studies are important to test for feasibility, evaluate and implement in order to be able to verify the program effectiveness and generalize results to the population.
Abstract: Introduction: The shoulder disorders have a high incidence and prevalence and its impact on patients’ life quality, makes relevant the search for the best intervention strategy in response to their needs. Musculoskeletal disorders of the shoulder have been associated with scapular dyskinesis, which is an alteration on resting position or dynamic motion of the scapula. The exercises for scapulothoracic dynamic stability allow the central nervous system regain movement patterns that do not compromise the shoulder joint structures and that are altered in the presence of dysfunction. The three-dimensional kinematic biofeedback has been shown to be an effective tool for recognizing the neutral zone and improving the quality of the scapula-focused exercises execution. Methodology: This methodological study aims to contribute to the development of a physiotheraphy scapula-focused exercise program for patients with shoulder dysfunction. This study involved a literature search in different international electronic databases in order to gather and synthesize existing evidence, and its development step involved four interlinked phases: critical analysis of the effectiveness ofphysiotherapy interventions for patients with shoulder dysfunction; description of the models and theories, in which physical therapy can be based to structure an intervention program for patients with shoulder dysfunction; identification and critical analysis of tools related to human movement used as feedback in the rehabilitation process; and, finally, development and detailed description of a physiotheraphy scapula-focused exercise program for patients with shoulder dysfunction, based on the result of the three previous stages. Results: A scapula-focused exercise program was developed based on three stages in accordance with a motor relearning model and dynamic stability using exercises and strategies described as more effective for the shoulder dysfunction, such as the use of three-dimensional kinematic biofeedback. This exercise program aims to reduce pain, restore function and promote correct kinematic patterns, leading to the adoption of appropriate movement strategies by the patient. Conclusion: This study represents the first step towards the development of a scapula-focused exercise program that aims to respond to the needs of patients with shoulder dysfunction. However further studies are important to test for feasibility, evaluate and implement in order to be able to verify the program effectiveness and generalize results to the population.
Description
Dissertação de Mestrado em Fisioterapia. Relatório de Projeto de Investigação
Keywords
shoulder intervention physiotherapy motor relearning scapulothoracic stability biofeedback complexo articular do ombro intervenção fisioterapia reaprendizagem motora estabilidade escápulo-torácica biofeedback
Citation
Publisher
Instituto Politécnico de Setúbal. Escola Superior de Saúde