Uso da realidade virtual centrada no cliente na reabilitação após acidente vascular encefálico: um estudo de viabilidade

Aramaki, Alberto Luiz; Sampaio, Rosana Ferreira; Cavalcanti, Alessandra; Dutra, Fabiana Caetano Martins Silva e

doi:10.1590/0004-282X20190103

Brazil

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Article • Arq. Neuro-Psiquiatr. 77 (9) • Set 2019 • https://doi.org/10.1590/0004-282X20190103 linkcopiar

Uso da realidade virtual centrada no cliente na reabilitação após acidente vascular encefálico: um estudo de viabilidade

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Programas de realidade virtual (RV) centrados no paciente poderiam auxiliar na recuperação funcional de pessoas após acidente vascular cerebral (AVC).

Objetivos: Analisar a viabilidade de um protocolo de reabilitação usando RV centrada no cliente e avaliar mudanças no desempenho ocupacional e na participação social.

Métodos: Dez pacientes com AVC participaram do programa de reabilitação utilizando RV por 40 min/dia, 3 dias/semana, durante 12 semanas. Foram coletadas informações sociodemográficas e as medidas de desfecho incluíram a Medida Canadense de Desempenho Ocupacional (COPM) e a Escala de Participação. Empregou-se um diário para registro da frequência e adesão de cada participante e uma entrevista foi usada para analisar a percepção dos participantes sobre o programa.

Resultados: Houve melhora estatisticamente significativa e clinicamente relevante no escore de desempenho da COPM (p < 0,001; IC = 1,219 − 4,858) e no escore de satisfação com o desempenho da COPM (p < 0,001; IC = 1,37 − 5,154); com diferença maior que 4,28 pontos para o desempenho; e 4,58 pontos para a satisfação. A mudança no escore de participação foi estatisticamente significativa (p = 0,046), mas não houve melhora clínica (d_cohen = −0,596, IC = −1,862 − 0,671). A maioria dos participantes apresentou mais de 75% de frequência consecutiva e houve 100% de adesão ao programa. Nas entrevistas os participantes relataram as dificuldades pós-AVC; como o video game motivou seu engajamento na reabilitação; e a melhora do desempenho ocupacional e da participação social após participar do programa.

Conclusões: Os resultados indicam a viabilidade da RV para reabilitação de pacientes com AVC, com ganhos funcionais, principalmente no desempenho ocupacional e satisfação com o desempenho.

Palavras-chave: Reabilitação; terapia de exposição à realidade virtual; jogos de vídeo; acidente vascular cerebral; assistência centrada no paciente

Variables	Princess Zelda	Kratos	Lara Croft	Solid Snake	Cloud	Jill Valentine	Sonic	Super Mario	Ryu	Chun-li
Sex	Female	Male	Female	Male	Male	Female	Male	Male	Male	Female
Age	59	31	36	21	44	38	32	57	38	57
Educational level	Incomplete elementary school	High school	High school	Incomplete high school	Incomplete higher education	Incomplete elementary school	Incomplete elementary school	Elementary school	Incomplete elementary school	Incomplete elementary school
Professional ties	Retired	On work leave	On work leave	Unemployed	Unemployed	On work leave	On work leave	On work leave	Retired	On work leave
Lives with	Partner	Parents	Parents, children and partner	Parents, children and partner	Parents, children and partner	Children	Alone	Parents, children and partner	Parents, children and partner	Parents, children and partner
Assistance in the ADL	Yes	No	Yes	No	Yes	Yes	Yes	Yes	No	No
Type of stroke	Hemorrhagic	Ischemic	Ischemic	Ischemic	Ischemic	Ischemic	Ischemic	Ischemic	Ischemic	Ischemic
Time since the stroke	9 months	24 months	12 months	24 months	24 months	2 months	3 months	7 months	12 months	3 months
Games used	20,000 Leaks	20,000 Leaks	20,000 Leaks	20,000 Leaks	20,000 Leaks	20,000 Leaks	20,000 Leaks	20,000 Leaks	20,000 Leaks	20,000 Leaks
	Boxing	Bowling	Bowling	Boxing	Bowling	Bowling	Bowling	Bowling	Boxing	Boxing
	Bowling	Track and Field	Golf	Bowling	Golf	Golf	Golf	Golf	Bowling	Bowling
	Golf	Traffic Control	Tennis	Table Tennis	Tennis	Tennis	Tennis	Table Tennis	Golf	Golf
	Table Tennis	Mouse Mayhem		Tennis				Tennis	Table Tennis	Table Tennis
	Tennis								Tennis	Tennis

Participant	Activity 1	Activity 2	Activity 3	Activity 4	Activity 5
Princess Zelda	Changing clothes	Eating	Making a meal	Washing clothes	Taking a bath
Kratos	Playing the violin	Riding a bike	Talking	Visiting friends	Traveling
Lara Croft	Taking a bath	Making a meal	Walking	Changing clothes	Eating
Solid Snake	Writing	Playing football	Following school subjects	Reading	Using the computer
Cloud	Changing clothes	Financial activities	Taking a bath	Using transportation	Traveling
Jill Valentine	Tying hair	Shopping	Talking	Cleaning the house	Visiting friends
Sonic	Playing football	Making a meal	Shaving	Changing clothes	Running
Super Mario	Changing clothes	Taking a bath	Walking	Shopping	Work activities
Ryu	Putting on sneakers	Playing football	Washing glasses	Shaving	Picking up objects at work
Chun-Li	Changing clothes	Eating	Putting food on the plate	Taking Walks	Talking

COPM domain	COPM category	Activity	Absolute frequency
Self-care	Personal care	Getting dressed	6
		Taking a bath	4
		Eating	3
		Shaving	2
		Hair brushing/grooming	1
	Functional mobility	Putting on sneakers	1
		Walking	2
		Shopping	2
	Independence away from home	Financial activities	1
		Using public transport	1
		Riding a bike	1
Productivity	Work	Work activities	1
	Work	Picking up objects at work	1
	Domestic tasks	Making a meal	3
		Washing clothes	1
		Cleaning the house	1
		Washing glasses	1
		Putting food on the plate	1
	School	Writing	1
		Following school subjects	1
		Reading	1
		Using the computer	1
Leisure	Quiet recreation	---	---
	Active recreation	Playing football	3
		Traveling	1
		Playing the violin	1
	Socialization	Talking	3
	Socialization	Visiting	2

Outcome	Mean (SD)	p-value	Sampling power	d_Cohen	d_cohen confidence interval
COPM pre-test performance	2.12 (0.81)	0.000	99%	3.038	1.219 − 4.858
COPM post-test performance	6.40 (1.82)	0.000	99%	3.038	1.219 − 4.858
COPM pre-test satisfaction	1.64 (0.88)	0.000	99%	3.262	1.37 − 5.154
COPM post-test satisfaction	6.22 (1.78)	0.000	99%	3.262	1.37 − 5.154
P-Scale pre-test	42.10 (26.42)	0.046	59.96%	-0.596	-1.862 to 0.671
P-Scale post-test	31.80 (28.29)	0.046	59.96%	-0.596	-1.862 to 0.671

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