Efeitos da estimulação transcraniana por corrente continua associada à fisioterapia na reabilitação do ombro doloroso pós acidente vascular cerebral – ensaio clínico, controlado, randomizado, duplo-cego

Abstract

Introduction: Painful shoulder is a common consequence after stroke, being considered a challenge in the rehabilitation of patients. Transcranial Direct Current Stimulation (tDCS) has been cited and used as an additional tool for analgesic effects in individuals with chronic pain. Objective: To evaluate the analgesic and functional effects of concomitant tDCS with physical therapy (TF) in patients with painful shoulder post stroke. Methods: Twenty-six hemiparetic adults with chronic shoulder pain were assessed before, after treatment, and 30 days after the end of treatment: Pain assessed by visual analog scale (VAS); motor impairment by the Fugl-meyer scale, hand grip strength with dynamometer, range of motion with goniometer, motor function by the Shoulder Pain and Disability Index, Disabilities of the Arm-Sholuder and Hand and quality of life by Stroke Specific Quality of Life Scale. Randomization for the two treatment groups: 1 (physical therapy associated active tDCS), 2 (physical therapy associated sham tDCS). Physiotherapy: passive mobilization and upper limb stretching (20 minutes) plus 20 minutes of active upper limb exercise of with associated cycle ergometer tDCS (2 mA); 5 sessions per week for 2 weeks totaling 10 sessions. Anode over injured C3 or C4 and supraorbital cathode contralateral to the anode.Results: There was a clinically significant decrease (<3 points) of pain for both groups, remaining at follow-up. There were no significant intergroup differences (p = 0,3). There was no difference after treatment and follow up for motor impairment and hand grip strength in both groups. The flexion, abduction, and external rotation range of motion best for the active ETCC group only. Motor function and quality of life improved after treatment and follow-up only intragroups without significant intergroup differences. Conclusion: Physical therapy was effective in reducing pain and improving the function and quality of life of patients with chronic post-stroke pain; however, the TDCS did not enhance these results.