INTRODUCTION

Stroke is defined as an interruption of the blood supply to the brain, usually due to the rupture of a blood vessel or its obstruction due to the presence of a clot¹. As a consequence, neurological damage occurs, such as deficits in motor, sensory, behavioral and perceptual functions.

For the systematic literature review (SLR) that we carried out, it is important to reflect specifically on the changes in motor and sensory function after stroke. Thus, the change in tone, namely spasticity (abnormal posture and stereotyped movement of a limb), requires our attention due to the risk of developing equine foot, which has an impact on mobility (gait) and on the person's balance. Likewise, the postural control mechanism can be affected in the individual who has had a stroke. Their daily life is changed as the change in postural control affects basic tasks such as rolling, sitting, standing and walking. In turn, the decrease in proprioceptive sensitivity (postural and vibratory) contributes to the loss of the ability to perform efficient and controlled movements, to the decrease in sensation and sense of position and movement, preventing and reducing new motor learning in the affected hemibody². Given the motor complications that the individual is subject to aft stroke, it is very important to act to prevent the loss of functional capacity associated with neurological deficits related to motor, sensory and postural functions.

Given the above, the Rehabilitation Nurse (RN) supports the decision-making in a documented manner, focusing on the quality and results of specialized care in rehabilitation nursing. According to the Regulation of Specific Competencies of the Specialist Nurse in Rehabilitation Nursing, the intervention area is directed towards the maintenance and promotion of well-being and quality of life, the recovery of functionality, maximization of capacities and prevention of complications, directed to the person throughout their life cycle ³.

In the process of foot rehabilitation in post-stroke patients, there are several rehabilitation techniques available, and in recent years the applicability of athletic tape (AT) or Kinesio tape (KT) has gained more followers and popularity, having been developed each time more studies about its usefulness in this process.

Kinesio Taping is a technique that involves the application of a therapeutic elastic band on the skin, and was developed in the 1970s by the Japanese chiropractor Kenzo Kase, with the objective of providing the patient with a therapeutic resource that would help the muscle and other tissues to achieve their homeostasis in the interval between chiropractic sessions. Some authors report that the technique is based on the induction of adequate sensory stimuli on the skin, through the application of an elastic band, which can be used to enhance and facilitate tissue and body homeostasis in any human condition ⁴. Having been developed to facilitate the body's natural healing process, while providing support and stability to muscles and joints without restricting the body's range of motion; it has been used to treat a variety of orthopedic, neuromuscular, neurological and medical conditions.

Athletic tapes can act on muscle, joints, lymphatic circulation, fascia, dermis, tendons and ligaments. Thus, the benefits advocated by neuromuscular bands can be subdivided into four major functions: dermal function, muscle function, joint function and lymphatic function. However, according to the technical manual, it is possible to stimulate or inhibit a certain muscle, using neuromuscular bands. The application of the neuromuscular band made in the direction of insertion to the origin of the muscle (from distal to proximal) would have an inhibitory effect and, when the direction of application of the neuromuscular band is from the origin to the insertion of the muscle (from proximal to distal); it would have muscle facilitation or stimulation effect ⁴.

According to Kenzo Kase (2003), this therapy aims to: relieve pain and abnormal sensations in the skin and muscles; to provide greater balance and support to the muscles during movements; to decrease lymphatic and blood edemas; to correct joint and biomechanical misalignments; to create more space at the epidermal, dermal and hypodermic levels; promote stimuli and improve proprioception ⁵.

Despite the application of neuromuscular bands in the field of neurology, be an increasingly reality, as mentioned above, the truth is that to date few studies have been carried out to validate their use in this population. The therapeutic effects advocated by the application of neuromuscular bands remain controversial and there is no scientific evidence to support them. Thus, having gained importance in recent years in its application in the field of neurology, it is interesting to clarify and validate this technique in the rehabilitation process of post-stroke patients at foot level. Like so, to find out what is the evidence on the application of neuromuscular bands in foot rehabilitation in post-stroke patients’ muscle ⁴.

METHOD

The Systematic Review followed the guidelines of the Joanna Briggs Institute (JBI). Selection criteria were defined and applied according to the PEO methodology that defines, according to Mendes et al (2008), the Population, the Exposure and the results, from the english Outcome ¹⁴. Participants: all adults diagnosed with stroke; Exposure: application of neuromuscular bands on the foot; Outcomes: rehabilitation. Only randomized clinical trials were selected.

During the month of July 2018, the search was carried out in the subsequent electronic scientific databases: Medline® and CINAHL®, defining as inclusion criteria the studies published in Portuguese, English and Spanish, with open access text and date from 2012 to 2018 and aged 19 years-old or over (all adults).

RESULTS AND DISCUSSION

In the particular analysis of the selected studies, there was a great heterogeneity of them, regarding the objectives, the method, the type of sample and the way they study the action of neuromuscular bands when applied to the foot in post-stroke patients.

From the analysis of the results of the studies included in this SLR, we can infer that the application of neuromuscular bands had positive effects in terms of balance, foot motor control, perception, ankle amplitude and gait.

In study 1, the authors reveal that after implementing the therapeutic plan that consisted of applying athletic tapes on foot, there is an improvement in perception, with consequences in improving the balance of individuals in the group ⁸.

Figure 1 Selection process diagram 

In the study carried out by Lima et al (study 2), the findings were not significant in terms of ankle amplitude gain. However, the authors report that study participants reported an improvement in gait, as well as in perception ⁹.

Regarding study 3, after the application of athletic tapes, the experimental group showed alterations in the center of balance ¹⁰.

Study 4 mentions a statistically significant improvement in terms of balance and foot motor control ¹¹.

Based on the data listed above, it is possible to verify that after placing the athletic tapes, the following gains are described: in balance (studies 1 and 4); in the change in the center of balance (study 3); in perception (studies 1 and 2); in foot control (study 4) and in gait (study 2). Although there is a relationship of gains after placement of athletic tapes in studies, its comparison is questionable due to the existing discrepancy in the design of the studies, in their methodology and sometimes hidden information, namely: type of stroke and respective area of ​​injury; post-stroke recovery time, care prior to the application of athletic tapes, detailed neuromuscular band application method; exposure time; scales and method of evaluating results.

The studies selected for this Systematic Review were assigned grade C regarding the degree of recommendation according to the quality of scientific evidence, according to the Jovell and Navarro-Rubio scale¹². Since there is insufficient scientific evidence, the decision to adopt the technology must be based on other criteria.

This Systematic Literature Review brings as main contribution to the practice of rehabilitation nurses the knowledge existing in the application of neuromuscular bands in the foot of the patient after a stroke. On the other hand, it guides for a more precise elaboration of new studies since it mentions the limitations found in the existing studies, as well as some suggestions.

CONCLUSIONS

Stroke has a great impact on a person's life cycle, as it acutely affects their health and quality of life. Nursing is a science that relates to transitional human experiences, in which health and well-being stand out as intervention outcomes; in this theoretical understanding, the challenge of the rehabilitation nurse professional centers on understanding the transition process, developing adaptive strategies that help the person to regain stability and well-being ¹³.

In this sense, it is up to the rehabilitation specialist nurse to implement rehabilitation programs based on the best existing evidence, in order to obtain gains that translate in recovery/minimization of post-stroke patient deficits. When performing this SLR, we verified there are some benefits in the application of athletic tapes in foot rehabilitation in post-stroke patients, namely in terms of body posture, gait and sensory perception. Despite the limitations found, which include the small number of studies, the small sample size and the methodological differences that make it difficult to compare the results, there was no compromise in achieving the goals initially outlined.

Therefore, we believe that it would be beneficial to carry out more studies in this area, taking into account a greater number of participants, a longer follow-up, a more detailed and monitored description of the application of neuromuscular bands, as well as the realization of a program of rehabilitation in order to complement this technique.