Neurorreabilitação funcional em lesões do plexo braquial em animais de companhia
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2019-01-17
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A lesão do plexo braquial é uma consequência da perda da condução do impulso nervoso, designando-se neuropraxia se a interrupção for reversível, ou neurotmese e axonotmese se a interrupção for completa. Em Medicina Veterinária não há uma opção que seja cientificamente aceite para tratamento de lesões do plexo braquial; pelo que, a opção mais viável é o tratamento conservativo (controlo da dor, proteção/suporte do membro e reabilitação). Uma vez que apenas 15 % dos animais com a enunciada lesão retorna a uma funcionalidade normal do membro afetado e, ainda, pelo facto da solução que é oferecida de forma mais comum aos tutores ser a amputação do membro lesionado; prendemo-nos com a necessidade de procurar opções que acarretem um maior sucesso clínico. Assim, comprometemo-nos a definir uma opção onde se adquira uma maior funcionalidade e qualidade de vida autónoma; bem como onde se modere a amputação dos membros afetados por este tipo de lesão. Para tal, exploramos o impacto da implementação de um protocolo de neurorreabilitação funcional eficaz e intensivo, que procure estimular mecanorrecetores, músculos, ligamentos, tendões e cápsulas articulares, a partir da sua ação nos centros neurais e nos fascículos nervosos sensoriais e motores; levando a cabo uma reorganização e regeneração nervosa através da neuroplasticidade sináptica e anatómica do sistema nervoso. Os objetivos deste estudo passaram por procurar saber se a neurorreabilitação funcional (com recurso a treino locomotor e eletroestimulação funcional) intensiva tem um papel na funcionalidade e na oportunidade de realização de uma recuperação motora e sensorial total, compatível com a normalidade, num período temporal menor. Perante isto, foi realizado o presente estudo em dois grupos de doentes com lesão do plexo braquial: no grupo controlo (n = 6) os animais foram sujeitos a protocolos base de fisioterapia (GLPB-BF) e no grupo em estudo (n = 6) sujeitos a protocolos de neurorreabilitação funcional (GLPB-NRF). Os resultados obtidos revelaram que 83,3 % da amostra do grupo em estudo (GLPBNRF) recuperou a sensibilidade à dor profunda e, que 66,7 % da amostra apresentou ausência de claudicação no membro lesionado e de défices sensoriais e motores, bem como normalização do reflexo flexor, no momento da alta clínica. Desta forma, concluiu-se que apesar do sucesso clínico ser multifatorial, os protocolos de neurorreabilitação, face aos protocolos base de fisioterapia, são indicativos de recuperação das fibras sensoriais C e da estimulação das despolarizações axonais, e, consequentemente, da condução nervosa necessária para se obter uma cocontração muscular alfa e gama; sempre tendo em vista o movimento articular global entre articulações que permita a amplitude de passo essencial à locomoção normal. Logo, estes protocolos permitem atingir uma maior funcionalidade, acompanhada de qualidade de vida autónoma, num intervalo de tempo menor.
The brachial plexus injury is a consequence of the loss of nerve impulse conduction, which is named neuropraxia if the interruption is reversible, or neurotmesis and axonotmesis if the interruption is complete. In Veterinary Medicine there is no option that is scientifically accepted for the treatment of brachial plexus injuries; therefore, the most viable option in the conservative treatment (pain control, limb protection/support and rehabilitation). Since only 15 % of the animals with this injury return the affected limb to its normal functionality and, also because the solution that is most commonly offered to tutors is the amputation of the injured limb; we get attached to the need to look for options that lead to a greater clinical success. Thus, we commit ourselves to define an option where the functionality and the autonomous quality of life are increased; as well as where we can moderate amputation of the injured limbs. To this end, we explored the impact of an effective and intensive functional neurorehabilitation protocol, which seeks to stimulate mechanoreceptors, muscles, ligaments, tendons and joint capsules, from their action in the neural centres and in the sensory and motor nervous fascicles; conducting to a reorganization and a neural regeneration through the synaptic and anatomical neuroplasticity of the nervous system. The aims of this study were to investigate whether functional neurorehabilitation (using locomotor training and functional electrical stimulation) has a role in the functionality and in the opportunity to perform a total motor and sensorial recovery, compatible with normality, in a shorter time. Therefore, the present study was carried out in two groups of animals with brachial plexus injury: in the control group (n = 6) the animals were submitted to classical physiotherapy protocols (GLPB-BF) and in the study group (n = 6) they were submitted to functional neurorehabilitation protocols (GLPB-NRF). The results revealed that 83,3 % of the sample in the study group (GLPB-NRF) recovered the sensitivity to deep pain and that 66,7 % of the same sample showed absence of claudication in the injured limb and of sensory and motor deficits, as well as normalization of the flexor reflex, at the time of clinical discharge. In conclusion, despite the multifactorial nature of the clinical success, the neurorehabilitation protocols, contrasting to the classical physiotherapy protocols, are indicative of recovery of the sensory C fibers and of the stimulation of axonal sprouting and, consequently of the nerve conduction necessary for alpha and gamma muscle cocontraction; always in view of the global joint movement between joints that allows the essential step amplitude for a normal locomotion. Then, these protocols allow to reach a greater functionality accompanied by autonomous quality of life, in a shorter period.
The brachial plexus injury is a consequence of the loss of nerve impulse conduction, which is named neuropraxia if the interruption is reversible, or neurotmesis and axonotmesis if the interruption is complete. In Veterinary Medicine there is no option that is scientifically accepted for the treatment of brachial plexus injuries; therefore, the most viable option in the conservative treatment (pain control, limb protection/support and rehabilitation). Since only 15 % of the animals with this injury return the affected limb to its normal functionality and, also because the solution that is most commonly offered to tutors is the amputation of the injured limb; we get attached to the need to look for options that lead to a greater clinical success. Thus, we commit ourselves to define an option where the functionality and the autonomous quality of life are increased; as well as where we can moderate amputation of the injured limbs. To this end, we explored the impact of an effective and intensive functional neurorehabilitation protocol, which seeks to stimulate mechanoreceptors, muscles, ligaments, tendons and joint capsules, from their action in the neural centres and in the sensory and motor nervous fascicles; conducting to a reorganization and a neural regeneration through the synaptic and anatomical neuroplasticity of the nervous system. The aims of this study were to investigate whether functional neurorehabilitation (using locomotor training and functional electrical stimulation) has a role in the functionality and in the opportunity to perform a total motor and sensorial recovery, compatible with normality, in a shorter time. Therefore, the present study was carried out in two groups of animals with brachial plexus injury: in the control group (n = 6) the animals were submitted to classical physiotherapy protocols (GLPB-BF) and in the study group (n = 6) they were submitted to functional neurorehabilitation protocols (GLPB-NRF). The results revealed that 83,3 % of the sample in the study group (GLPB-NRF) recovered the sensitivity to deep pain and that 66,7 % of the same sample showed absence of claudication in the injured limb and of sensory and motor deficits, as well as normalization of the flexor reflex, at the time of clinical discharge. In conclusion, despite the multifactorial nature of the clinical success, the neurorehabilitation protocols, contrasting to the classical physiotherapy protocols, are indicative of recovery of the sensory C fibers and of the stimulation of axonal sprouting and, consequently of the nerve conduction necessary for alpha and gamma muscle cocontraction; always in view of the global joint movement between joints that allows the essential step amplitude for a normal locomotion. Then, these protocols allow to reach a greater functionality accompanied by autonomous quality of life, in a shorter period.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária apresentada à Universidade de Trás-os-Montes e Alto Douro
Palavras-chave
Neurorreabilitação , lesão plexo braquial , avulsão , contratura fibrótica , cão , gato