Avaliação do impacto das abordagens bottom-up e top-down nas atividades da vida diária em pessoas com neglect – revisão sistemática

Abstract

INTRODUÇÃO: Atualmente não existe um consenso entre quais as caraterísticas das abordagens (bottom-up ou top-down) mais eficazes na reabilitação das Atividades da Vida Diária (AVDs) em pessoas com Síndrome de Neglect (SN). OBJETIVO: Caracterizar as abordagens (bottom-up ou top-down) e o seu impacto nas AVDs em adultos e idosos com SN. MÉTODOS: Esta revisão sistemática foi realizada de acordo com a recomendação PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A pesquisa bibliográfica foi realizada nas bases de dados PubMed, Web of Science, PEDro e Cochrane. Foram considerados estudos experimentais em que pelo menos uma técnica das abordagens bottom-up e top-down fosse utilizada. A ferramenta Joanna Briggs Institute Critical Appraisal Checklist for RCTs foi utilizada para avaliar a qualidade metodológica dos estudos. Foi usada a seguinte combinação de palavras chave: Neglect Syndrome OR Unilateral Syndrome OR Neglect (…) AND Activities of Daily Living OR Daily (…) AND Treatment OR Intervention OR Technique (…). RESULTADOS: Foram incluídos 16 estudos, dos quais 9 incluem técnicas de abordagem bottom-up, 6 incluem técnicas de abordagem top-down e 1 artigo inclui técnicas das duas abordagens. As técnicas da abordagem bottom- up que aumentaram a independência nas AVDs foram Visuomotor Feedback Training, Smooth Pursuit Eye Movement Training e a combinação de Eye Patching com Constraint-induced Therapy. Na abordagem top-down as técnicas com os mesmos resultados foram Visual Scanning, Mental Practice, Continuous Theta Burst Stimulation e Transcranial Direct Current Stimulation. CONCLUSÃO: As abordagens bottom-up e top-down aumentam a independência nas AVDs e cada uma contém técnicas com significativo impacto positivo, como Visuomotor Feedback Training e Continuous Theta Burst Stimulation. O presente trabalho permitiu uma análise crítica à classificação das abordagens em bottom-up e top-down, uma vez que não são sensíveis à distinção dos mecanismos de reabilitação envolvidos.

BACKGROUND: Currently there is no consensus on which are the characteristics of rehabilitation approaches (bottom-up or top-down) most effective in the rehabilitation of ADLs in people with Neglet Syndrome (NS). AIM: To characterize the approaches (bottomup or top-down) with more impact on ADLs in adults and elderly with NS. METHODS: This systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) recommendation. A bibliographic search was carried out in PubMed, Web of Science, PEDro and Cochrane databases. Experimental studies were considered in which at least one technique of the bottom-up and top-down approaches was used. The Joanna Briggs Institute Critical Appraisal Checklist for RCTs tool was used to assess the methodological quality of the studies. The following combination of keywords was used: Negligence Syndrome OR Unilateral Syndrome OR Negligence (...) AND Activities OF Daily OR Daily Life (...) AND Treatment OR Intervention OR Technique (...). RESULTS: 16 studies were included, which 9 include techniques from the bottom-up approach, 6 include techniques from the top-down approach and 1 article includes two techniques, each belonging to each approach. The techniques of the bottom-up approach that increased independence in the ADLs were Visuomotor Feedback Training, Smooth Pursuit Eye Movement Training and the combination of Eye Patching with Constraint-induced Therapy. In the top-down approach, the techniques with the same results were Visual Scanning, Mental Practice, Continuous Theta Burst Stimulation and Transcranial Direct Current Stimulation. CONCLUSION: Both bottom-up and top-down approaches increase independence in ADLs. Each approach contains techniques with a significant positive impact on ADLs such as Visuomotor Feedback Training and Continuous Theta Burst Stimulation. The present work also allowed a critical analysis to the classification of the approaches in bottom-up and top-down, since they are not different to the category of rehabilitation mechanisms