Degenerescência do disco intervertebral toracolombar: avaliação do efeito da neurorreabilitação funcional
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2016
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Esta Dissertação de Mestrado é subordinada ao papel da neurorreabilitação funcional
na doença degenerativa do disco intervertebral. Esta doença é uma das causas mais comuns de
disfunção neurológica em cães. A neurorreabilitação funcional baseia-se nas propriedades da
medula espinhal, tais como a neuroplasticidade, neuromodulação e memorização. Os seus
protocolos são implementados após uma abordagem de diagnóstico correta por parte do
neurologista ou neurocirurgião veterinário.
O presente estudo tem como objetivo avaliar a importância da neurorreabilitação
funcional na recuperação da capacidade ambulatória e funcional de cães com doença
degenerativa do disco intervertebral toracolombar.
No presente trabalho foram incluídos 98 cães com diagnóstico de doença
degenerativa do disco intervertebral toracolombar que foram sujeitos a um protocolo de
neurorreabilitação funcional no Centro de Reabilitação Animal da Arrábida (Azeitão,
Portugal), aonde permaneceram em regime de internamento. Este protocolo incluiu técnicas
de eletromioestimulação, treino locomotor terrestre e aquático e modalidades
complementares, no sentido de promover a estimulação das vias motoras descendentes, assim
como os geradores de padrão central, de modo a que a libertação de correntes despolarizantes
permitisse uma locomoção equilibrada e coordenada.
A amostra foi composta por 46 machos e 52 fêmeas, com idades compreendidas
entre os 2 e 16 anos de idades, peso vivo médio de 14 Kg e de diferentes raças. Em relação à
doença do disco, 58 animais apresentavam hérnias de Hansen tipo I e 40 de Hansen tipo II.
O presente estudo demonstrou que, para existir locomoção voluntária funcional, é
imprescindível a presença de sensibilidade à dor profunda, embora, tal não seja limitante, pois
a mesma esteve presente em 75,5% dos cães e, ainda assim, foi atingindo um sucesso clínico
de 80,7%, incluindo-se aqui animais que alcançaram a locomoção fictícia funcional.
Demonstrou-se também que, independentemente do tipo de hérnia, são necessários, em
média, 2 meses para se alcançar o estado ambulatório e funcional.
O sucesso clínico nestes casos é uma conjugação multifatorial da extensão da lesão,
velocidade da hérnia, utilização de glucocorticoides, estado de perfusão sanguíneo e
oxigenação da medula, presença de sensibilidade à dor profunda e aplicação da
neurorreabilitação funcional.
This Master Thesis is regarding the functional neurorehabilitation role in the intervertebral disc disease. This is a common disease causing neurologic dysfunction in dogs. In functional neurorehabilitation it’s needed to understand spinal cord properties like neuroplasticity, neuromodulation and memorization. Functional neurorehabilitation protocols must be applied after a correct diagnose by the veterinary neurologist or neurosurgeon’s decision about resolution. The study aimed to evaluate the functional neurorehabilitation on the recovery of ambulatory and functional capacity in dogs with thoracolombar intervertebral disc disease. In the present study were included 98 dogs with thoracolombar intervertebral disc disease diagnostic, which were subjected to a functional neurorehabilitation protocol on Centro de Reabilitação Animal da Arrábida (Azeitão, Portugal), where they remained. This protocol included electromyostimulation techniques, terrestrial and aquatic locomotor training and complementary modalities, in an effort to promote descendent motor pathways stimulation and central pattern generators, so that persistent inward currents allow a coordinated and balanced locomotion. The sample was composed by 46 males and 52 females, with ages between 2 and 16 years, average weight of 14 kg and from several breeds. Regarding the disc disease, 58 had type I Hansen hernia and 40 had type II Hansen hernia. The present study shown that to exist functional voluntary locomotion it is necessary the presence of deep pain perception, although, this is not limiting, as this one was present in 75.5% of the dogs and, even so, there was reached an 80.7% of clinical success, which were included animals that achieve fictitious functional locomotion. It was also proved that it’s necessary in average two months to achieve a functional ambulatory state independently of the type of hernia. This is also an important and concrete information to the owners. It is is important to refer the clinical success in this cases it is a multifactorial conjugation between lesion extension, lesion velocity, glucocorticoids usage, medullary blood perfusion and oxygenation, deep pain perception and functional neurorehabilitation application.
This Master Thesis is regarding the functional neurorehabilitation role in the intervertebral disc disease. This is a common disease causing neurologic dysfunction in dogs. In functional neurorehabilitation it’s needed to understand spinal cord properties like neuroplasticity, neuromodulation and memorization. Functional neurorehabilitation protocols must be applied after a correct diagnose by the veterinary neurologist or neurosurgeon’s decision about resolution. The study aimed to evaluate the functional neurorehabilitation on the recovery of ambulatory and functional capacity in dogs with thoracolombar intervertebral disc disease. In the present study were included 98 dogs with thoracolombar intervertebral disc disease diagnostic, which were subjected to a functional neurorehabilitation protocol on Centro de Reabilitação Animal da Arrábida (Azeitão, Portugal), where they remained. This protocol included electromyostimulation techniques, terrestrial and aquatic locomotor training and complementary modalities, in an effort to promote descendent motor pathways stimulation and central pattern generators, so that persistent inward currents allow a coordinated and balanced locomotion. The sample was composed by 46 males and 52 females, with ages between 2 and 16 years, average weight of 14 kg and from several breeds. Regarding the disc disease, 58 had type I Hansen hernia and 40 had type II Hansen hernia. The present study shown that to exist functional voluntary locomotion it is necessary the presence of deep pain perception, although, this is not limiting, as this one was present in 75.5% of the dogs and, even so, there was reached an 80.7% of clinical success, which were included animals that achieve fictitious functional locomotion. It was also proved that it’s necessary in average two months to achieve a functional ambulatory state independently of the type of hernia. This is also an important and concrete information to the owners. It is is important to refer the clinical success in this cases it is a multifactorial conjugation between lesion extension, lesion velocity, glucocorticoids usage, medullary blood perfusion and oxygenation, deep pain perception and functional neurorehabilitation application.
Descrição
Orientação : João Filipe Requicha
Palavras-chave
MESTRADO INTEGRADO EM MEDICINA VETERINÁRIA, VETERINÁRIA, CÃES, NEURORREABILITAÇÃO, NEUROPLASTICIDADE, DOGS, NEUROREHABILITATION, NEUROPLASTICITY, CANÍDEOS, CANIDS, DOENÇAS DEGENERATIVAS, DEGENERATIVE DISEASES, MEDICINA VETERINÁRIA, VETERINARY MEDICINE, REABILITAÇÃO FUNCIONAL, FUNCTIONAL REHABILITATION