Análise da função respiratória e do controle postural de indivíduos após acidente vascular cerebral (AVC) hospitalizados

Abstract

Introduction: Approximately 90% of stroke survivors experience some form of disability, leading to prolonged dysfunction and limitations that may persist for months, years, or even a lifetime. These impairments significantly impact the ability to perform daily activities and, consequently, social participation. Objective: To analyze respiratory function and postural control in individuals hospitalized following a stroke. Materials and Methods: This observational, cross-sectional study included a convenience sample of stroke patients hospitalized in Salvador, BA. Eligible participants were adults aged 21 to 85 years with a confirmed diagnosis of ischemic and/or hemorrhagic stroke who were unable to walk unassisted and admitted to a neurology referral unit. Exclusion criteria included a history of previous stroke, respiratory diseases, other neurological diagnoses, cognitive impairments preventing comprehension of test instructions, use of an artificial airway, and contagious diseases transmitted via contact or respiratory routes. Sociodemographic and clinical data were collected during hospitalization, along with an assessment of stroke severity using the National Institute of Health Stroke Scale. Respiratory function was evaluated using cirtometry, manovacuometry, and peak flow tests. Postural control was assessed with the Postural Assessment Scale for Stroke Patients in hemiparetic individuals. Results: A total of 28 stroke patients were evaluated, 60.7% of whom were male, with a mean age of 56.89 ± 14.61 years. Ischemic stroke was predominant (71.4%), with 57.1% exhibiting left-sided motor impairment and a mean stroke severity score of 6.11 ± 5.07. All individuals demonstrated reduced thoracic mobility, with umbilical variation being the most restricted measurement. Maximum respiratory pressures were also diminished, with maximal inspiratory pressure (MIP) at 49% and maximal expiratory pressure (MEP) at 52% of predicted values. The mean peak cough flow (PCF) was 184.2 ± 87.4 L/min. MIP showed a weak negative correlation with stroke severity (r = -0.493, p = 0.014), while MEP exhibited a moderate negative correlation (r = -0.543, p = 0.006). Among the 16 individuals with left hemiparesis, 56.3% were male, with a mean age of 56.31 ± 14.14 years. Ischemic stroke was predominant (62.5%), with a mean severity score of 7.53 ± 5.73. Thoracic mobility remained reduced, with axillary variation showing the greatest restriction. Maximum respiratory pressures were 46% of the predicted value, and mean PCF was 192.3 ± 87.57 L/min. While postural control impairments were observed, no significant correlation was found between postural control and respiratory variables. Conclusion: A negative correlation was identified between respiratory muscle strength and stroke severity in hospitalized individuals. Moreover, individuals with mild to moderate neurological impairment exhibited respiratory muscle weakness and reduced thoracic mobility compared to predicted values. No significant correlation was found between thoracic mobility, respiratory muscle strength, PCF, and postural control in hospitalized hemiparetic individuals. However, the overall sample demonstrated reduced thoracic mobility and maximum respiratory pressures, indicating respiratory muscle weakness, alongside significant postural control decline.