Estimulación cerebral no invasiva en la enfermedad pulmonar obstructiva crónica: una serie de casos
DOI:
https://doi.org/10.34024/rnc.2024.v32.15956Palabras clave:
EPOC, entrenamiento de los músculos inspiratorios, neuromodulación, capacidad funcional, disneaResumen
Introducción. La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad respiratoria crónica caracterizada por síntomas como disnea, tos y obstrucción persistente de las vías respiratorias. En esta población se encuentra con frecuencia intolerancia al ejercicio, así como limitaciones en la capacidad respiratoria, obstrucción de las vías respiratorias y fatiga de los músculos respiratorios. Este estudio tiene como objetivo evaluar los efectos de la estimulación de la corteza motora diafragmática mediante alta definición: estimulación transcraneal de corriente continua (HD-tDCS) asociada con un protocolo de entrenamiento de los músculos inspiratorios (IMT) sobre la capacidad funcional y sensación de disnea en pacientes con EPOC. Método. Esta serie de casos siguió a tres pacientes con diferentes grados de afectación pulmonar debido a EPOC, que se sometieron a un protocolo de 20 minutos de HD-tDCS asociado con GIM, realizado dos veces por semana durante 6 semanas. Resultados. Tras el protocolo se observó una mejora de 22 metros en el 6MWT y de 1,66 en el Medical Research Council modificado (mMRC). También podemos observar un aumento en el IMP sostenido y la resistencia de los músculos respiratorios con ganancias promedio respectivas (20,55 y 6,67 cmH2O) entre los dos momentos. Conclusiones. Estos resultados muestran que HD-tDCS asociada con IMT tiene efectos beneficiosos sobre la sensación de disnea, la capacidad funcional, la fuerza y la resistência de los músculos respiratorios en pacientes con EPOC.
Descargas
Citas
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2023 report). 2023 (acessado em: 18/09/2023). Disponível em: https://goldcopd.org/2023-gold-report-2/
Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigare R, et al. An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Resp Crit Care Med 2014;189:e15-62. https://doi.org/10.1164/rccm.201402-0373ST
Singer J, Yelin EH, Katz PP, Sanchez G, Iribarren C, Eisner MD, et al. Respiratory and skeletal muscle strength in chronic obstructive pulmonary disease: impact on exercise capacity and lower extremity function. J Card Rehab Prev 2011;31:111-9. https://doi.org/10.1097/HCR.0b013e3182033663
Mantoani LC, Rubio N, McKinstry B, MacNee W, Rabinovich RA. Interventions to modify physical activity in patients with COPD: a systematic review. Eur Resp J 2016;48:69-81. https://doi.org/10.1183/13993003.01744-2015
Watz H, Pitta F, Rochester CL, Garcia-Aymerich J, ZuWallack R, Troosters T, et al. An official European Respiratory Society statement on physical activity in COPD. Eur Resp J 2014;44:1521-37. https://doi.org/10.1183/09031936.00046814
Silva CMDSE, Gomes Neto M, Saquetto MB, Conceição CSD, Souza-Machado A. Effects of upper limb resistance exercise on aerobic capacity, muscle strength, and quality of life in COPD patients: a randomized controlled trial. Clin Rehab 2018;32:1636-44. https://doi.org/10.1177/0269215518787338
Pilloni G, Bikson M, Badran BW, George MS, Kautz SA, Okano AH, et al. Update on the use of transcranial electrical brain stimulation to manage acute and chronic COVID-19 symptoms. Front Hum Neurol 2020;14:595567. https://doi.org/10.3389/fnhum.2020.595567
Laviolette L, Niérat MC, Hudson AL, Raux M, Allard E, Similowski T. The supplementary motor area exerts a tonic excitatory influence on corticospinal projections to phrenic motoneurons in awake humans. PloS One 2013;8:1-9. https://doi.org/10.1371/journal.pone.0062258
Nakayama T, Fujii Y, Suzuki K, Kanazawa I, Nakada T. The primary motor area for voluntary diaphragmatic motion identified by high field fMRI. J Neurol 2004;251:730-5. https://doi.org/10.1007/s00415-004-0413-4
Azabou E, Bao G, Heming N, Bounab R, Moine P, Chevallier S. Randomized controlled study evaluating efficiency of low intensity transcranial direct current stimulation (tDCS) for dyspnea relief in mechanically ventilated COVID-19 patients in ICU: the tDCS-DYSP-COVID protocol. Front Med 2020;7:558317. https://doi.org/10.3389/fmed.2020.00372
Pollastri L, Gallo G, Zucca M, Filipas L, La Torre A, Riba U, et al. Bilateral Dorsolateral Prefrontal Cortex High-Definition Transcranial Direct-Current Stimulation Improves Time-Trial Performance in Elite Cyclists. Int J Sport Phys Perform 2021;16:224-31. https://doi.org/10.1123/ijspp.2019-0910
Andrade SM, Batista LM, Nogueira LL, Oliveira EAD, Carvalho AG, Lima SS. Constraint-induced movement therapy combined with transcranial direct current stimulation over premotor cortex improves motor function in severe stroke: a pilot randomized controlled trial. Rehabil Res Pract 2017;2017:6842549. https://doi.org/10.1155/2017/6842549
Azabou E, Roche N, Sharshar T, Bussel B, Lofaso F, Petitjean M. Transcranial direct-current stimulation reduced the excitability of diaphragmatic corticospinal pathways whatever the polarity used. Resp Phys Neurol 2013;189:183-7. https://doi.org/10.1016/j.resp.2013.07.024
Raux M, Xie H, Similowski T, Koski L. Facilitatory conditioning of the supplementary motor area in humans enhances the corticophrenic responsiveness to transcranial magnetic stimulation. J Appl Phys 2012;108:39-46. https://doi.org/10.1152/japplphysiol.91454.2008
Abodonya AM, Abdelbasset WK, Awad EA, Elalfy IE, Salem HA, Elsayed SH. Inspiratory muscle training for recovered COVID-19 patients after weaning from mechanical ventilation: A pilot control clinical study. Medicine 2021;100:e25339. https://doi.org/10.1097/MD.0000000000025339
Dias FD, Sampaio LMM, Silva GA, Gomes ÉLD, Nascimento ESP, Alves VLS. Home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized clinical trial. Int J Chron Obstruct Pulmon Dis 2013;8:537-44. https://doi.org/10.2147/COPD.S50213
Ministério da Saúde. Relatório de Recomendação: protocolo clínico e diretrizes terapêuticas da doença pulmonar obstrutiva crônica. Conitec, 2021 (acessado em: 13/09/2023). Disponível em: https://www.gov.br/saude/pt-br/assuntos/protocolos-clinicos-e-diretrizes-terapeuticas-pcdt
Santoro A, Tomino C, Prinzi G, Lamonaca P, Cardaci V, Fini M, et al. Tobacco smoking: risk to develop addiction, chronic obstructive pulmonary disease, and lung cancer. Rec Pat Anti-Can D Disc 2019;14:39-52. https://doi.org/10.2174/1574892814666190102122848
Nascimento LCS, Nunes LKRS, Santos EA, Alves ASS. Physiotherapy approach in the lung rehabilitation of COPD patients: an integrative review. RSD 2022;11:e496111033249. https://doi.org/10.33448/rsd-v11i10.33249
Andrade JD, Barreto Neto J, Teixeira AKAAF, Tojal AST, Cerqueira Neto ML, Oliveira GU, et al. Existe correlação entre escala modified medical research concil e teste de caminhada de 6 minutos em DPOC? VIII SULBRAFIR. ASSOBRAFIR Ciência 2015;6(suppl 1):236. https://assobrafirciencia.org/article/5ddbc9dc0e88250c62f2c91e/pdf/assobrafir-6-Suplemento+1-213.pdf
Gosselink R, De Vos J, Van Den Heuvel SP, Segers J, Decramer M, Kwakkel G. Impact of inspiratory muscle training in patients with COPD: what is the evidence?. Eur Resp J 2011;37:416-25. https://doi.org/10.1183/09031936.00031810
Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J. American thoracic society/European respiratory society statement on pulmonary rehabilitation. Am J Resp Crit Care Med 2006;173:1390-413. https://doi.org/10.1164/rccm.200508-1211ST
Mota JC, Santos MRD, Sousa LRD, Abdoral PRG, Abdoral LSR, Miranda CJCDP. Treinamento muscular inspiratório em pessoas com doença pulmonar obstrutiva crônica (DPOC): uma revisão sistemática. Fisioter Pesq 2023;30:e21028823en. https://doi.org/10.1590/1809-2950/e21028823pt
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2024 Aline Araújo Candeia, Wanessa do Nascimento Ferreira, Roberto Vinicius Antonio da Costa, Laura Natália Freitas Cavalcante Tenório, Ewerton Graziane Gomes dos Santos, Iara Tainá Cordeiro de Souza, Tatiana Onofre Gama, Jose Heriston de Morais Lima, Rafaela Pedrosa, Eduardo Eriko Tenório França
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Português
English
Español
