Neuromodulation and physiotherapy: state of art

Abstract

Physiotherapy through sensorimotor stimuli accesses the Nervous System promoting neuromodulation [1]. Depending on the motor response of the individual, the physiotherapist selects which movements should be restricted and / or facilitated, in order to optimize motor recovery [2]. Thus, an integrative review of the state of the art on the effects of Physical Therapy on the neurosensor-motor modulation was structured. The facilitation and restriction of movement have the ability respectively to stimulate and inhibit neural circuits, modeling the brain pattern. After brain injury, it is usual to identify, on the hemiplegic side, absence and / or difficulty in movement preformance. However, it is important to identify the compensatory strategies present in the non hemiplegic side. Their presence suggests hyperactivity of the uninjured hemisphere associated with hyperactive motor behavior. This neurophysiological response compromises recovery. In this context, the use of less injured upper limb restriction may contribute to reduce levels of neural excitability and stimulate ipsilesional hemispheric activation, associated with more favorable outcomes. However, it is important primarily, to achieve brain function modulation, to promote biomechanical integrity, namely the position and orientation of body segments. In cerebral modulation we can consider some fundamental aspects: 1) the movement may be dependent on the dominant hemisphere (mostly on the upper limb); 2) automatic movements, with consolidated learning, are more likely to be reactivated; 3) interaction with the environment and 4) central nervous system afferences can be performed through the senses (smell, sight, hearing, touch and taste) [3]. Specificity in stimulus selection seems to be an essential factor for motor recovery and brain modulation.