Reeducação da Marcha na Lesão Medular, a Propósito de Dois Sistemas Robóticos: o Lokomat® e o EKSO GT®

Gonçalo Pires, Jorge Fortunato, Isabel Amorim, Filipa Faria

Resumo


Um dos principais objetivos da reabilitação após a instalação de lesão medular consiste na reeducação funcional da marcha. Esta abordagem pode estar associada à reconfiguração dos reflexos espinhais e interneurónios, permitindo potenciar a neuroplasticidade que leva à recuperação da capacidade para a marcha. Os impulsos aferentes da carga e posição da anca são cruciais na geração de um padrão de marcha e consequentemente no treino funcional da marcha. Os sistemas robóticos são uma abordagem introduzida recentemente, com o objetivo da recuperação da capacidade de marcha em doentes com lesão medular incompleta, permitindo um treino consistente, com maior intensidade, num ambiente seguro. A evolução funcional é avaliada através de testes e escalas adequadas para a lesão medular. A utilização dos sistemas robóticos implica um conhecimento vasto acerca das indicações, benefícios, limitações e medidas de segurança necessárias para cada dispositivo e cada doente. São vários os tipos de sistemas robotizados, atualmente disponíveis para utilização na reabilitação da marcha. Não obstante, os autores pretendem através deste artigo, expor as principais vantagens e limitações, de dois sistemas robóticos, o Lokomat® e o EKSO GT®, bem como realizar uma revisão sumária da neurofisiologia e avaliação de fatores de prognóstico para realizar marcha após uma lesão medular.


Palavras-chave


Lesão Medular/reabilitação; Marcha; Robótica

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DOI: http://dx.doi.org/10.25759/spmfr.273

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Revista da Sociedade Portuguesa de Medicina Física e de Reabilitação