Ispilu terapia iktusaren ondorengo goiko gorputz adarraren errehabilitazioan: datu neurofisiologikoak eta klinikoak

Abstract

[EUS] Sarrera: Azken 15 urteetan zehar mundu mailako heriotza kausa nagusienak kardiopatia iskemikoa eta iktusa izan dira. Euskadin 6000 iktus kasu berri ematendira urtean, eta 1.400 lagun hiltzen dira horren ondorioz. Gainera, hiltzen ez diren helduetan ezgaitasun fisikoa sortzen duen kausarik nagusiena da. Datozen hamarkadetan arazo honek sortzen duen kostua handitzea espero da biztanleriaren zahartze prozesua dela eta. Maila funtzionalean eragin larriak sor ditzake, besteak beste martxarako zailtasunak eta goiko gorputz adarrarekin erlazionaturikoak, eragozpenak sortuz eguneroko bizitzan eta bizi-kalitatean. Karga hau gutxitzeko, paziente askok errehabilitazio multidisziplinarioa jasotzen dute. Gaur egun ez dago tratamendu sendagarririk, ondorioz, errehabilitazioko esku-hartzeetara jotzen da. Errehabilitazio prozesua aurrera joaten da garun plastikotasuna deritzon fenomenoari esker. Teknika ezberdin asko erabiltzen dira. Horietako bat ispilu terapia da,berrantolaketa kortikala sustatzeko metodo eraginkorra kontsideratzen dena.Helburua: Errebisio bibliografiko honen helburua iktusaren ondorioz sortutako goiko gorputz adarraren paresiaren tratamenduan ispilu terapiaren eraginkortasuna aztertzea da, datu neurofisiologikoak klinikan lortutako datuekin alderatuz. Materialak eta metodoak: Errebisio sistematiko bat burutu da Pubmed, Web of Science, PEDro eta Cochrane Library datu base elektronikoetan, honako hitz gakoakerabiliz: stroke, upper limb, mirror therapy, mirror box therapy, mirror visual feedback, neuronal plasticity, neural plasticity eta neural reorganization. Emaitzak: Bilaketa egin ondoren 110 ikerketa aurkitu dira. Horietatik 10-ek bete dituzte hautaketa irizpideak. Lauk datu neurofisiologikoak aztertzen dituzte.Horietako bi entsegu klinikoak dira, eta beste biak errebisioak. Gainontzeko seiak datu klinikoak aztertzen dituzte. Horietako 5 entsegu klinikoak dira, eta azkena errebisioa da. Ondorioak: Ikusi da ispilu bidezko feedback bisualak eragin modulatzaile sendoa duela sistema motorrean garun plastikotasunean eragiten duen heinean. Hala ere, ikerketa gehiago behar dira hobekuntza klinikoak eta feedback bisualaren bidezko garun plastikotasunaren patroia zuzenean konparatzen dituztenak, aktibazio patroi hau hobekuntza klinikoekin bat datorren baieztatu ahal izateko.

[EN] Introduction: In the last 15 years, the main causes of deaths worldwide have been ischemic heart disease and stroke. In the Basque Country, there are 6,000 new cases of stroke per year, and 1,400 people die as a result. In addition, it is the leading cause of physical disability in surviving adults. In the coming decades, the cost of this problem is expected to increase due to the aging process of the population. It can cause serious effects at the functional level, such as difficulty in walking and problems related to the upper limb, which in turn creates problems in daily living activities and in the perception of quality of life. To reduce this burden, many pati ents receive multidisciplinary rehabilitation. Currently there is no curative treatment, so it is addressed through rehabilitation interventions. The rehabilitation process is carried out through a phenomenon called cerebral plasticity. Many different techniques are used. One of them is mirror therapy, which is considered an effective method for cortical reorganization.Objective: The aim of this literature review is to analyze the efficacy of mirror therapy in the treatment of upper extremity paresis caused by stroke, comparing the neurophysiological data with the clinical assessment. Materials and methods: A systematic review was carried out by searching Pubmed, Web of Science, PEDro and Cochrane Library, using the following keywords stroke, upper limb, mi rror therapy, mirror box therapy, mirror visual feedback, neuronal plasticity, neural plasticity and neural reorganization. Results: After the search, 110 investigations were found. 10 of them have met the selection criteria. Four analyze neurophysiological data: two are clinical trials, and the other two are reviews. The other six analyze clinical data: five are clinical trials, and the last one is a review.Conclusions: It has been proven that mirror visual feedback has a strong modulating effect on the motor system because it influences cerebral plasticity. However, more research is needed to directly compare clinical improvements and the pattern of cerebral plasticity influenced by visual feedback, to confirm that this pattern of activation is in line with clinical improvements.