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  • ¿Qué capacidad tienen los pacientes con dolor lumbar de generar imágenes motoras?

¿Qué capacidad tienen los pacientes con dolor lumbar de generar imágenes motoras?

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La imaginería motora es la habilidad cognitiva de generar imágenes motoras sin realizarlas físicamente (Decety, 1996). Diversas investigaciones han determinado que este proceso cerebral produce una activación cortical similar a la que se produce con la planificación y ejecución del movimiento (Decety, 1996; Roth et al., 1996)

En pacientes con dolor crónico lumbar se ha identificado la presencia de cambios neuro-plásticos en áreas de procesamiento somato-sensorial, afectivo y cognitivo (Grachev, Fredrickson, & Apkarian, 2002; Lloyd, Findlay, Roberts, & Nurmikko, 2008; Wand et al., 2011), pero además se ha observado que estos pacientes presentan una planificación del movimiento disfuncional, y alteraciones en los ajustes posturales anticipatorios que podrían deberse al dolor o ha diversos factores psicológicos asociados (Jacobs, Henry, & Nagle, 2009; Meier et al., 2016; Vrana et al., 2015).

Los pacientes con dolor lumbar crónico presentan una disminución de la capacidad de generar imágenes motoras visuales y cinestésicas

Por otra parte,  Vrana y cols, realizaron un estudio en el que aplicaron un proceso de imaginería motora de movimientos lumbares, y al valorar el proceso mediante neuroimagen descubrieron que los pacientes con dolor lumbar presentan una alteración del procesamiento de las áreas relacionadas con la planificación del movimiento, como por ejemplo el área motora suplementaria (Vrana et al., 2015).

Teniendo en cuenta estos antecedentes  La Touche y cols,  han planteado un estudio para determinar la capacidad de generar imágenes motoras de tipo visual y cinestésico de pacientes con dolor lumbar crónico (La Touche et al., 2018), los resultados de esta investigación demuestran que estos pacientes tienen una disminución  de la capacidad  para generar imágenes motoras visuales y cinestésicas en comparación con sujetos asintomáticos. Además se encontró que esta capacidad disminuida podría estar relacionado con la disminución del movimiento, la discapacidad lumbar y bajos niveles de autoeficacia (La Touche et al., 2018).

Este estudio puede ayudar a generar nuevas propuestas de investigaciones que ayuden a identificar las implicaciones clínicas que pueda tener el déficit en la generación de imágenes motoras y las futuras propuestas terapéuticas.

Este articulo de divulgación esta basado en la siguiente investigación:

La Touche, R., Grande-Alonso, M., Cuenca-Martínez, F., Gónzalez-Ferrero, L., Suso-Martí, L., & Paris-Alemany, A. (2018). Diminished kinesthetic and visual motor imagery ability in adults with chronic low back pain. PM & R : The Journal of Injury, Function, and Rehabilitation. https://doi.org/10.1016/j.pmrj.2018.05.025

 

Bibliografía

Decety, J. (1996). The neurophysiological basis of motor imagery. Behavioural Brain Research77(1–2), 45–52.

Grachev, I. D., Fredrickson, B. E., & Apkarian, A. V. (2002). Brain chemistry reflects dual states of pain and anxiety in chronic low back pain. Journal of Neural Transmission (Vienna, Austria : 1996)109(10), 1309–34. https://doi.org/10.1007/s00702-002-0722-7

Jacobs, J. V., Henry, S. M., & Nagle, K. J. (2009). People with chronic low back pain exhibit decreased variability in the timing of their anticipatory postural adjustments. Behavioral Neuroscience, 123(2), 455–458. https://doi.org/10.1037/a0014479

La Touche, R., Grande-Alonso, M., Cuenca-Martínez, F., Gónzalez-Ferrero, L., Suso-Martí, L., & Paris-Alemany, A. (2018). Diminished kinesthetic and visual motor imagery ability in adults with chronic low back pain. PM & R : The Journal of Injury, Function, and Rehabilitation. https://doi.org/10.1016/j.pmrj.2018.05.025

Lloyd, D., Findlay, G., Roberts, N., & Nurmikko, T. (2008). Differences in low back pain behavior are reflected in the cerebral response to tactile stimulation of the lower back. Spine33(12), 1372–7. https://doi.org/10.1097/BRS.0b013e3181734a8a

Meier, M. L., Stämpfli, P., Vrana, A., Humphreys, B. K., Seifritz, E., & Hotz-Boendermaker, S. (2016). Neural Correlates of Fear of Movement in Patients with Chronic Low Back Pain vs. Pain-Free Individuals. Frontiers in Human Neuroscience10, 386. https://doi.org/10.3389/fnhum.2016.00386

Roth, M., Decety, J., Raybaudi, M., Massarelli, R., Delon-Martin, C., Segebarth, C., … Jeannerod, M. (1996). Possible involvement of primary motor cortex in mentally simulated movement: a functional magnetic resonance imaging study. Neuroreport7(7), 1280–4.

Vrana, A., Hotz-Boendermaker, S., Stämpfli, P., Hänggi, J., Seifritz, E., Humphreys, B. K., & Meier, M. L. (2015). Differential Neural Processing during Motor Imagery of Daily Activities in Chronic Low Back Pain Patients. PLOS ONE10(11), e0142391. https://doi.org/10.1371/journal.pone.0142391

Wand, B. M., Parkitny, L., O’Connell, N. E., Luomajoki, H., McAuley, J. H., Thacker, M., & Moseley, G. L. (2011). Cortical changes in chronic low back pain: current state of the art and implications for clinical practice. Manual Therapy16(1), 15–20. https://doi.org/10.1016/j.math.2010.06.008

 

Roy La Touche Arbizu

Profesor. Doctor. Fisioterapeuta


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