Estímulo vibracional na espasticidade
uma perspectiva de tratamento
DOI:
https://doi.org/10.4181/RNC.2010.ip02.7pPalavras-chave:
Mecanorreceptores, Espasticidade Muscular, Vibração, Reabilitação, Vias NeuraisResumo
A espasticidade é um distúrbio neurológico proveniente da lesão de um neurônio motor superior e da desorganização dos circuitos neurais da medula espinhal, que acarreta alterações sensório-motoras de graduações variadas. Técnicas farmacológicas, fisioterápicas e cirúrgicas são utilizadas para reduzir a espasticidade. Os objetivos deste artigo são apresentar e discutir a viabilidade de utilizar estímulos vibracionais no tratamento fisioterápico. Ondas oscilatórias geradas por estímulos vibracionais aplicados ao paciente são captadas por receptores periféricos causando ilusão de movimento. A plasticidade neural é evocada por estímulos físicos, como o movimento da perna, ou artificialmente, com estimulação elétrica funcional. Aplicando-se estímulo vibracional sobre orgão tendinoso de Golgi e utilizando-se de análise por imagem, pesquisadores obtiveram ativação de diversas regiões cerebrais, corroborando a hipótese de que o estímulo vibracional é eficaz nos distúrbios de movimento de origem neurológica. Os parâmetros ajustados para proporcionar ilusão de movimento encontrados na literatura são: frequência entre 1 e 140 Hz; força entre 0,5 e 9 N; e amplitude de 0,005 a 2 mm. Da pesquisa realizada, conclui-se que a vibração sobre receptores sensoriais acarreta em ativação cortical e esporadicamente na ativação motora agonista ou antagonista. Do ponto de vista clínico, o estímulo vibracional mostra-se eficaz no tratamento da espasticidade.
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Barnes S, Gregson J, Leathley M, Smith T, Sharma A, Watkins C. Development and inter-rater reliability of an assessment tool for measuring muscle tone in people with hemiplegia after a stroke. Physiotherapy1999;85:405-9.
Teive HAG, Zonta M, Kumagai Y. Tratamento da espasticidade: uma atualização. Arq Neuropsiquiatr 1998;56: 852-8.
Stokes M. Neurologia para fisioterapeutas. Colômbia: Premier, 2000, 402p.
Mirbagheri MM, Settle K, Harvey R, Rymer WZ. Neuromuscular abnormalities associated with spasticity of upper extremity muscles in hemiparetic stroke. J Neurophysiol 2007;98:629.
Crone C, Petersen NT, Nielsen JE, Hansen NL, Nielsen JB. Reciprocal inhibition and corticospinal transmission in the arm and leg in patients with autosomal dominant pure spastic paraparesis (ADPSP). Brain 2004;127:2693.
Vorrink SN, Van der Woude LH, Messenberg A, Cripton PA, Hughes B, Sawatzky BJ. Comparison of wheelchair wheels in terms of vibration and spasticity in people with spinal cord injury. J Rehab Res Develop 2008;45:1269-80.
Tsai KH, Chun-Yu YEH, Chang HY, Jia-Jin C. Effects of a single session of prolonged muscle stretch on spastic muscle of stroke patients. Proc Natl Sci Counc ROC (B) 2001;25:76-81.
Carr JH, Shepherd RB, Ada L. Spasticity: research findings and implications for intervention. Physiotherapy 1995;81:421-9.
Machado ABM. Neuroanatomia Funcional. 2ed. São Paulo: Atheneu, 2006, 363p.
Rapp Jr CE, Torres MM. The adult with cerebral palsy. Arch Fam Med 2000;9:466-72.
O’Dwyer NJ, Ada L, Neilson PD. Spasticity and muscle contracture following stroke. Brain 1996;119:1737-49.
Crone C, Johnsen LL, Biering-Sorensen F, Nielsen JB. Appearance of reciprocal facilitation of ankle extensors from ankle flexors in patients with stroke or spinal cord injury. Brain 2003;126:495-507.
Burke D, Andrews J, Gillies J. The reflex response to sinusoidal stretching in spastic man. Brain 1971;94:455-70.
Corrêa FI, Soares F, Andrade DV, Gondo RM, Peres JA, Fernandes AO, et al. Atividade muscular durante a marcha após acidente vascular encefálico. Arq Neuropsiquiatr 2005;63:847-51.
Allison SC, Abraham LD. Sensitivity of qualitative and quantitative spasticity measures to clinical treatment with cryotherapy. Inter J Rehab Res 2001;24:15-24.
Tuke A. Constraint-induced movement therapy: a narrative review. Physiotherapy 2008;94:105-14.
Junqueira RT, Ribeiro AMB, Scianni AA. Efeitos do fortalecimento muscular e sua relação com a atividade funcional e a espasticidade em indivíduos hemiparéticos. Rev Bras Fisioter 2004;8:247-52.
Gelber DA, Jozefczyk PB. Therapeutics in the management of spasticity. Neurorehabil Neural Repair 1999;13:5-14.
Oliviero A, Rubio-Esteban M, Foffani G, Aguilar J, Lopez-Dolado E, Arzoz-Lezaun T, et al. Effects of baclofen on temperature perception in humans. Neurosci Res 2007; 59:89-92.
Schmidtbleicher D, Haas CT, Turbanski S. Vibration Training in Rehabilitation. Proceedings of the International Symposium on Biomechanics in Sports XXIII; 2005. p. 71-9.
Hagbarth KE, Eklund G. Tonic vibration reflexes (TVR) in spasticity. Brain Res 1966;2:201-3.
Cordo P, Lutsep H, Cordo L, Wright WG, Cacciatore T, Skoss R. Assisted Movement With Enhanced Sensation (AMES): Coupling Motor and Sensory to Remediate Motor Deficits in Chronic Stroke Patients. Neurorehabil Neural Repair 2009; 23:67-77.
Chae J, Hart R. Intramuscular hand neuroprosthesis for chronic stroke survivors. Neurorehabil Neural Repair 2003;17:109-17.
Agne JE. Eletroterapia: Teoria e prática. Santa Maria: Orium, 2005, 336p.
Rushton DN. Functional electrical stimulation. Physiol Meas 1997;18:241-76.
Bachschmidt RA, Harris GF, Simoneau GG. Walker-assisted gait in rehabilitation: a study of biomechanics andinstrumentation. IEEE Trans Neural Syst Rehabil Eng 2001;9:96-105.
Matsunaga T, Shimada Y, Sato K. Muscle fatigue from intermittent stimulation with low and high frequency electrical pulses. Arch Phys Med Rehabil 1999;80:48-53.
Popovic MR, Thrasher TA. Neuroprostheses. In: Bowlin GL, Wnek G, eds. Encyclopedia of Biomaterials and Biomedical Engineering. New York: Informa Healthcare 2004, p.1056-65.
McAndrew DJ, Rosser NAD, Brown JMM. Mechanomyographic measures of muscle contractile properties are influenced by the duration of the stimulatory pulse. J Appl Res 2006;6:142-52.
Nogueira-Neto GN, Müller RW, Salles FA, Nohama P, Button VLS. Mechanomyographic sensor. International Joint Conference on Biomedical Engineering Systems and Technology. Funchal, 2008, p.176-9.
Petrofsky JS. Electrical stimulation: neurophysiological basis and application. Basic Appl Myol 2004;14:205-13.
Robinson AJ, Snyder-Mackler L. Eletrofisiologia clínica: eletroterapia e teste eletrofisiológico. 2 ed. Porto Alegre: Artemed, 2001, 426p.
Watkins CA. Mechanical and neurophysiological changes in spastic muscles: serial casting in spastic equinovarus following traumatic brain injury. Physiotherapy 1999; 85:603-9.
Lundbye-Jensen J, Nielsen JB. Central nervous adaptations following 1 wk of wrist and hand immobilization. J Appl Physiol 2008;105:139-51.
Armutlu K, Meric A, Kirdi N, Yakut E, Karabudak R. The effect of transcutaneous electrical nerve stimulation on spasticity in multiple sclerosis patients: a pilot study. Neurorehabil Neural Repair 2003;17:79-82.
McLellan DL. Effect of baclofen upon monosynaptic and tonic vibration reflexes in patients with spasticity. Br Med J 1973;36:555-60.
Cardoso E, Pedreira G, Prazeres A, Ribeiro N, Melo A. Does botulinum toxin improve the function of the patient with spasticity after stroke? Arq Neuropsiquiatr 2007;65:592-5.
Chae J, Yang G, Park BK, Labatia I. Muscle weakness and cocontraction in upper limb hemiparesis: relationship to motor impairment and physical disability. Neurorehab Neural Repair 2002;16:241-8.
Segura DCA, Adamchuk CC, Nascimento FC, Moraes NV. A utilização da toxina botulínica associada à fisioterapia para o controle da espasticidade; The botulinum toxin utilization associated to physiotherapy for the control of spasticity. Arq Ciênc Saúde Unipar 2005;9:217-22.
Lampropulos M, Puigdevall M. Toxina botulinica en paralisis cerebral infantil; Botulinum toxin in children with cerebral palsy. Rev Argent Neuroc 2004;18):23-6.
Lee SU, Bang MS, Han TR. Effect of cold air therapy in relieving spasticity: applied to spinalized rabbits. Spinal Cord 2002;40:167-73.
Albert F, Bergenheim M, Ribot-Ciscar E, Roll JP. The Ia afferent feedback of a given movement evokes the illusion of the same movement when returned to the subject via muscle tendon vibration. Exp Brain Res 2006; 172:163-74.
Fattorini L, Ferraresi A, Rodio A, Azzena GB, Filippi GM. Motor performance changes induced by muscle vibration. Eur J Appl Physiol 2006;98:79-87.
Stillman BC. Vibratory motor stimulation - a preliminary report. Aust J Physiother 1970;16:118-23.
Burke D, Schiller HH. Discharge pattern of single motor units in the tonic vibration reflex of human triceps surae. J Neurol Neurosurg Psychiatr 1976;39:729-41.
Nardone A, Schieppati M. Reflex contribution of spindle group Ia and II afferent input to leg muscle spasticity as revealed by tendon vibration in hemiparesis. Clin Neurophysiol 2005;116:1370-81.
Verschueren SMP, Cordo PJ, Swinnen SP. Representation of wrist joint kinematics by the ensemble of muscle spindles from synergistic muscles. J Neurophysiol 1998; 79:2265-76.
Roll JP, Albert F, Thyrion C, Ribot-Ciscar E, Bergenheim M, Mattei B. Inducing any virtual two-dimensional movement in humans by applying muscle tendon vibration. J Neurophysiol 2009;101:816-23.
Shinohara M, Moritz CT, Pascoe MA, Enoka RM. Prolonged muscle vibration increases stretch reflex amplitude, motor unit discharge rate, and force fluctuations in a hand muscle. J Appl Physiol 2005;99:1835-42.
Floeter MK, Zhai P, Saigal R, Kim Y, Statland J. Motor neuron firing dysfunction in spastic patients with primary lateral sclerosis. J Neurophysiol 2005;94:919-27.
Gillies JD, Lance JW, Neilson PD, Tassinari CA. Presynaptic inhibition of the monosynaptic reflex by vibration. J Physiol 1969;205:329-39.
Bear MF, Connors BW, Paradiso MA. Neurociências: Desvendando o sistema nervoso. 2 ed. Porto Alegre: Artmed, 2002, 855p.
Kandel ER, Jessell TM, Schwartz JH. Principles of neural science. 3 ed. New York: Elsevier 1991, 1137p.
Klomkleaw W, Kasashima Y, Kobayashi A, Fuller G, Morimoto M, Nakade T, et al. Tubular aggregates observed in spindle muscle fiber of horse lumbrical muscle. Acta Neuropathol 2001;101:509-17.
Cohen H. Neurociências para Fisioterapeutas. 2 ed. Barueri: Manole, 2001, 519p.
Schmidt R, Dudel J, Jänig W, Zimmermann M. Neurofisiologia. São Paulo: EPU, 1979, 372p.
Pierrot-Deseilligny E, Burke DC. The circuitry of the human spinal cord: its role in motor control and movement disorders. Cambridge: University Press, 2005, 642p.
Dindar F, Verrier M. Studies on the receptor responsible for vibration induced inhibition of monosynaptic reflexes in man. J Neurol Neurosurg Psychiatr 1975;38:155-60.
Calvin-Figuiere S, Romaiguere P, Gilhodes JC, Roll JP. Antagonist motor responses correlate with kinesthetic illusions induced by tendon vibration. Exp Brain Res 1999; 124:342-50.
Ribot-Ciscar E, Butler JE, Thomas CK. Facilitation of triceps brachii muscle contraction by tendon vibration after chronic cervical spinal cord injury. J Appl Physiol 2003;94:2358-67.
Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965;150:971-8.
Loeser JD, Melzack R. Pain: an overview. The Lancet 1999;353:1607-9.
Dessy LA, Monarca C, Grasso F, Saggini A, Buccheri EM, Saggini R, et al. The Use of Mechanical Acoustic Vibrations to Improve Abdominal Contour. Aesth Plast Surg 2008;32:339-45.
Hill SL, Webber B. Mucus transport and physiotherapy--a new series. Eur Respir J 1999;13:949-50.
Turbanski S, Haas CT, Schmidtbleicher D, Friedrich A, Duisberg P. Effects of random whole-body vibration on postural control in Parkinson’s disease. Res Sports Med 2005;13:243-56.
Hagbarth KE, Eklund G. The effects of muscle vibration in spasticity, rigidity, and cerebellar disorders. J Neurol Neurosurg Psychiatr 1968;31:207-13.
Childers MK, Biswas SS, Petroski G, Merveille O. Inhibitory casting decreases a vibratory inhibition index of the H-reflex in the spastic upper limb. Arch Phys Med Rehab 1999;80:714-6.
Cordo PJ, Gurfinkel VS, Brumagne S, Flores-Vieira C. Effect of slow, small movement on the vibration-evoked kinesthetic illusion. Exp Brain Res 2005;167:324-34.
Cordo PJ, Flores-Vieira C, Verschueren SMP, Inglis JT, Gurfinkel V. Position sensitivity of human muscle spindles: single afferent and population representations. J Neurophysiol 2002;87:1186-95.
Hatzitaki V, Pavlou M, Bronstein AM. The integration of multiple proprioceptive informations: effect of ankle tendon vibration on postural responses to platform tilt. Exp Brain Res 2004;154:345-54.
Kitada R, Naito E, Matsumura M. Perceptual changes in illusory wrist flexion angles resulting from motor imagery of the same wrist movements. Neurosci Behav Physiol 2002;109:701-7.
Bernier PM, Chua R, Inglis JT, Franks IM. Sensorimotor adaptation in response to proprioceptive bias. Exp Brain Res 2007;177:147-56.
Rosenkranz K, Rothwell JC. Spatial attention affects sensorimotor reorganisation in human motor cortex. Exp Brain Res 2006;170:97-108.
Hagbarth KE, Kunesch EJ, Nordin M, Schmidt R, Wallin EU. Gamma loop contributing to maximal voluntary contractions in man. J Physiol 1986;380:575-91.
Burke D, Andrews CJ, Lance JW. Tonic vibration reflex in spasticity, Parkinson’s disease, and normal subjects. J Neurol Neurosurg Psychiatr 1972;35:477-86.
Westlake KP, Culham EG. Sensory-Specific Balance Training in Older Adults: Effect on Proprioceptive Reintegration and Cognitive Demands. Phys Ther 2007; 87:1274-83.
Gorassini MA, Knash ME, Harvey PJ, Bennett DJ, Yang JF. Role of motoneurons in the generation of muscle spasms after spinal cord injury. Brain 2004;127:2247-58.
Cody FWJ, Richardson HC, MacDermott N, Ferguson IT. Stretch and vibration reflexes of wrist flexor muscles in spasticity. Brain 1987;110:433-50.
Naito E, Roland PE, Grefkes C, Choi HJ, Eickhoff S, Geyer S, et al. Dominance of the right hemisphere and role of area 2 in human kinesthesia. J Neurophysiol 2005; 93:1020-34.
Lundbye-Jensen J, Nielsen JB. Immobilization induces changes in presynaptic control of group Ia afferents in healthy humans.J Physiol 2008;586:4121-35.
Morita H, Crone C, Christenhuis D, Petersen NT, Nielsen JB. Modulation of presynaptic inhibition and disynaptic reciprocal Ia inhibition during voluntary movement in spasticity. Brain 2001;124:826-37.
Lavrov I, Gerasimenko YP, Ichiyama RM, Courtine G, Zhong H, Roy RR, et al. Plasticity of spinal cord reflexes after a complete transection in adult rats: relationship to stepping ability. J Neurophysiol 2006;96:1699-710.
Morita H, Shindo M, Momoi H, Yanagawa S, Ikeda S, Yanagisawa N. Lack of modulation of Ib inhibition during antagonist contraction in spasticity. Neurology 2006; 67:52-6.
Erhart EA. Neuroanatomia. 4 ed. São Paulo: Atheneu, 1972, 420p
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Publicado: 2010-12-31
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