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Contributo da terapia por caixa de espelho para a autonomia no autocuidado – Programa de intervenção.
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Abstract(s)
Cuidar, conceito central da enfermagem, exige que os enfermeiros prestem cuidados de qualidade, centrados na pessoa. Na área especializada do cuidar, a diferenciação dos conhecimentos e atributos técnicos dos enfermeiros de reabilitação ajudam na definição da sua intervenção assente nos programas de reabilitação e que visa na sua essência a promoção da autonomia/independência no autocuidado.
A pessoa vivencia inúmeras transições saúde/doença ao longo da sua vida que colocam em risco a independência no autocuidado, pondo à prova a capacidade da pessoa de se adaptar às modificações produzidas em si mesma.
De entre as incapacidades provocadas pelo AVC, a alteração da função dos membros superiores pode constituir-se como uma das mais limitativas. Recorde-se que o membro superior intervém em muitos autocuidados, pelo que muito da independência para o autocuidado pode passar pela forma como se reabilita este membro. O enfermeiro sustenta muito das suas intervenções nos autocuidados daí a importância do uso do Modelo do Autocuidado no suporte da análise da problemática.
Desta forma, o retorno da função do membro superior tem sido identificado como um importante objetivo na reabilitação destes doentes e, consequentemente, uma preocupação dos enfermeiros de reabilitação. Para tal, o enfermeiro utiliza técnicas e terapias especificas de reabilitação cuja prática baseada na evidência dita a integração das mesmas nos programas de intervenção.
Objetiva-se assim avaliar o contributo da terapia por caixa de espelho para a autonomia no autocuidado nos doentes com hemiplegia/hemiparesia por AVC da artéria cerebral média.
Concretiza-se assim num estudo baseado no paradigma quantitativo, de natureza transversal e de carácter quase-experimental, com um desenho de pré e pós-programa com grupo de controlo. A amostra é constituída por 30 participantes admitidos numa unidade de convalescença e num serviço de medicina física e de reabilitação. O instrumento de colheita de dados foi selecionado de modo a verificar as respostas nas variáveis força de preensão manual e digital, amplitude de movimento articular do membro superior, equilíbrio corporal estático na posição sentado, destreza manual/motricidade fina da mão, dor, extinção/desatenção e grau de autonomia/independência no autocuidado, pelo que do instrumento fizeram parte o dinamómetro hidráulico de mão e de dedo, o goniómetro, a escala de Berg, o teste 9 – PnB, a escala Numérica da dor, a escala de NIHSS e o instrumento de Grau de autonomia/independência no autocuidado.
Na caracterização da amostra demonstrou-se homogeneidade entre grupos verificando-se semelhança nas características sociodemográficas e clínicas particularmente no grau de autonomia/independência no autocuidado higiene e arranjo pessoal, no autocuidado vestir/despir e na maioria das dimensões dos autocuidados alimentar e tomar banho. Apenas ocorreu diferença na dor, na dimensão entrar/sair do chuveiro do autocuidado tomar banho e nas dimensões mastigar e engolir do autocuidado alimentar.
Verificou-se nos resultados, ganhos mais expressivos no grupo experimental mas sem significado estatístico de diferença entre grupos na recuperação motora do membro superior particularmente na força de preensão manual e digital, na amplitude do movimento articular do membro superior e na destreza manual/motricidade fina da mão.
Em síntese o estudo sustenta-se numa amostra reduzida não demonstrando diferenças estatísticas entre grupos contudo há ganhos com maior expressão no grupo submetido à terapia por caixa de espelho do que no grupo não sujeito a esta.
Caring, the central concept of nursing requires nurses to provide quality and person-centered care. In the specialised area of care, the differentiation of knowledge and technical attributes of rehabilitation nurses helps in defining its intervention based in rehabilitation programs and aimed the promotion of autonomy/independence in self-care. The person experiences countless transitions health/illness throughout his life that puts at risk the independence in self-care, testing the person's ability to adapt to the changes. Among the disabilities caused by stroke, changes in upper limbs function can be one of the most restrictive. The upper limb is active in many self-care activities, so much of independence for self-care depends on the way member is rehabilitated. The nurse maintains much of its interventions in self-care so the importance of using self-care model in the problem analysis support. Thus, the return of the upper extremity function has been identified as an important objective in the rehabilitation of these patients and therefore a concern of rehabilitation nurses. The nurse uses evidence-based practice techniques and specific rehabilitation therapies which promotes the integration of these same on the intervention programs. Objective is to evaluate the contribution of a mirror box therapy for autonomy in self-care in hemiplegic/hemiparetic patients after stroke of the middle cerebral artery. So it materializes in a study based on the quantitative paradigm, cross-cutting and quasi-experimental nature, with a pre and post-design program with control group. The sample consists of 30 participants admitted to the convalescent unit and physical medicine and rehabilitation service. The data collection instrument was selected to verify the answers in force variable manual and digital hold, joint range of motion of the upper limb, static balance in the sitting position, manual dexterity/fine hand motor function, pain, extinction/inattention and self-care, so the instrument were part of the hydraulic dynamometer hand and finger, the goniometer, the Berg scale, the test 9 – PnB, the numerical pain scale, the NIHSS scale and the instrument of autonomy/independence in self-care. In the sample characterization was demonstrated homogeneity between groups verified similarity in the socio-demographic characteristics and clinical characteristics particularly in autonomy/independence degree in hygiene and personnel arrangement self-care, self-care dressing/undressing and in most dimensions of food self-care and bath. The only difference was in pain, dimension enter/exit of the shower on the bath self-care and dimensions chew and swallow of food self-care. The results showed more significant gains in the experimental group but not statistically significant difference between groups in the motor arm recovery particularly in strength of manual and digital hold, the amplitude of the upper limb joint movement and manual dexterity/fine motor skills of hand. In summary the study holds up on a small sample showing no statistical differences between groups however there are gains with higher expression in the group undergoing mirror box therapy than in the group not subject to this.
Caring, the central concept of nursing requires nurses to provide quality and person-centered care. In the specialised area of care, the differentiation of knowledge and technical attributes of rehabilitation nurses helps in defining its intervention based in rehabilitation programs and aimed the promotion of autonomy/independence in self-care. The person experiences countless transitions health/illness throughout his life that puts at risk the independence in self-care, testing the person's ability to adapt to the changes. Among the disabilities caused by stroke, changes in upper limbs function can be one of the most restrictive. The upper limb is active in many self-care activities, so much of independence for self-care depends on the way member is rehabilitated. The nurse maintains much of its interventions in self-care so the importance of using self-care model in the problem analysis support. Thus, the return of the upper extremity function has been identified as an important objective in the rehabilitation of these patients and therefore a concern of rehabilitation nurses. The nurse uses evidence-based practice techniques and specific rehabilitation therapies which promotes the integration of these same on the intervention programs. Objective is to evaluate the contribution of a mirror box therapy for autonomy in self-care in hemiplegic/hemiparetic patients after stroke of the middle cerebral artery. So it materializes in a study based on the quantitative paradigm, cross-cutting and quasi-experimental nature, with a pre and post-design program with control group. The sample consists of 30 participants admitted to the convalescent unit and physical medicine and rehabilitation service. The data collection instrument was selected to verify the answers in force variable manual and digital hold, joint range of motion of the upper limb, static balance in the sitting position, manual dexterity/fine hand motor function, pain, extinction/inattention and self-care, so the instrument were part of the hydraulic dynamometer hand and finger, the goniometer, the Berg scale, the test 9 – PnB, the numerical pain scale, the NIHSS scale and the instrument of autonomy/independence in self-care. In the sample characterization was demonstrated homogeneity between groups verified similarity in the socio-demographic characteristics and clinical characteristics particularly in autonomy/independence degree in hygiene and personnel arrangement self-care, self-care dressing/undressing and in most dimensions of food self-care and bath. The only difference was in pain, dimension enter/exit of the shower on the bath self-care and dimensions chew and swallow of food self-care. The results showed more significant gains in the experimental group but not statistically significant difference between groups in the motor arm recovery particularly in strength of manual and digital hold, the amplitude of the upper limb joint movement and manual dexterity/fine motor skills of hand. In summary the study holds up on a small sample showing no statistical differences between groups however there are gains with higher expression in the group undergoing mirror box therapy than in the group not subject to this.
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Keywords
Autocuidado Hemiplegia Terapia por caixa de espelho. Hemiparesia