Dispositivo de suporte para o ombro parético após um acidente vascular encefálico: uma revisão da literatura

Abstract

Stroke is a neurological condition, which is the leading cause of disability in adults in working age and has negative impacts on quality of life, besides being the major cause of morbidity and mortality worldwide. Decreases in upper limb function are frequent complaints leading to difficulties in the execution of manual tasks and instrumental daily living activities, which compromise the return to work, the social life and have negative impacts on the overall recovery process. After stroke, many patients may develop pain on the paretic shoulder and among those who demonstrate little or no active movements of the upper limb, the chance could reach 80%. Another problem often encountered is the shoulder subluxation. Considering the need for therapeutic approaches based upon scientific evidences and, at the same time, feasible to be implemented in clinical practice, the aim of this literature review was to verify the scientific evidences regarding the efficacy of shoulder support devices in the prevention, reduction of pain and subluxation, as well as to evaluate their impact on functional recovery during the acute and subacute phases of stroke. The following electronic databases were searched: Cochrane, MEDLINE, PEDro, PubMed, and SciELO, as well as manual search on the reference lists of the included articles. The key words included combinations and variations of the following terms: Stroke, hemiplegia, cerebrovascular disorders, physical therapy, orthotic devices, strapping, sling, arm support, upper extremity orthoses, shoulder pain, shoulder subluxation, and upper extremity. Out of the five included studies, two evaluated the use of slings and three investigated the use of "tapping" and had their methodological quality assessed by the PEDro scale. Three studies scored 3/10 and the others 6/10 and 7/10, respectively. According to this review, there was not found enough evidence to assert that the use of these devices was effective in reducing or preventing shoulder subluxation and improving functional recovery in stroke patients. When the paretic upper limb was supported mainly in the acute phases, little evidence was found that these devices could slightly delay the onset of pain, but not completely prevent it.