Control motor. De la investigación a la práctica clínica

284

PARTE II  Control postural

,, $OWHUDFLRQHV HQ OD HVWUXFWXUD IXQFLyQ FRUSRUDOHV $ $OWHUDFLRQHV GHO VLVWHPD PRWRU

0RYLPLHQWR YROXQWDULR DLVODGR FXDQGR VH OH SLGH TXH PXHYD VX EUD]R GHUHFKR WLHQH IOH[LyQ SDUFLDO HQ HO FRGR \ HO KRPEUR UHDOL]DGR GHQWUR GH XQD VLQHUJLD GH IOH[RUHV &RQ VX EUD]R DSR\DGR SDUD PLQLPL]DU HO HIHFWR GH OD JUDYHGDG QR WLHQH H[WHQVLyQ DFWLYD GH VX EUD]R SDUpWLFR 7DPSRFR WLHQH H[WHQVLyQ DFWLYD GH OD PXxHFD R ORV GHGRV &XDQGR WUDWD GH H[WHQGHU OD PDQR \ OD PXxHFD HQ OXJDU GH VHOHFFLRQDU ORV H[WHQVRUHV VHOHFFLRQD XQD VLQHUJLD GH IOH[RUHV TXH SURGXFH IOH[LyQ GHO EUD]R &XDQGR VH OH SLGH TXH IOH[LRQH VX SLHUQD SDUpWLFD IOH[LRQD OD FDGHUD \ OD URGLOOD \ FRPLHQ]D D VHOHFFLRQDU ORV GRUVLIOH[RUHV GHO WRELOOR GHQWUR GH XQ SDWUyQ GH VLQHUJLD IOH[RUD $VLPLVPR DO H[WHQGHU VX SLHUQD VH VHOHFFLRQDQ ORV IOH[RUHV SODQWDUHV GHQWUR GH XQ SDWUyQ GH VLQHUJLD H[WHQVRUD &XDQGR VH OH SLGH TXH PXHYD VyOR HO WRELOOR QR SXHGH DLVODU HO PRYLPLHQWR GHO WRELOOR \ HQ FDPELR VHOHFFLRQD WDQWR ORV GRUVLIOH[RUHV GHO WRELOOR FRPR ORV IOH[RUHV SODQWDUHV GHQWUR GH XQ SDWUyQ GH VLQHUJLD WRWDO $PSOLWXG GH PRYLPLHQWR WLHQH DPSOLWXG GH PRYLPLHQWR FRPSOHWD DO QLYHO GHO KRPEUR \ HO FRGR SHUR HVWi FRPHQ]DQGR D GHVDUUROODU WLUDQWH] HQ ORV IOH[RUHV GH OD PXxHFD \ ORV GHGRV 7LHQH DPSOLWXG GH PRYLPLHQWR OLPLWDGD HQ ORV GRUVLIOH[RUHV GHUHFKRV (VSDVWLFLGDG HO HVWLUDPLHQWR UiSLGR GHO EtFHSV IOH[RUHV GH OD PXxHFD \ IOH[RUHV SODQWDUHV GHO WRELOOR LQGLFD OD SUHVHQFLD GH HVSDVWLFLGDG 6X SXQWXDFLyQ HQ OD HVFDOD GH HVSDVWLFLGDG GH $VKZRUWK HV GH % 6HQVDFLyQ *HQLVH WLHQH DOWHUDFLyQ GHO WDFWR OHYH GLVFULPLQDFLyQ GH GRV SXQWRV \ SURSLRFHSFLyQ HQ VX EUD]R \ SLHUQD SDUpWLFRV /D SpUGLGD GLVWDO HV PD\RU TXH OD SpUGLGD SUR[LPDO 1R WLHQH SUREOHPDV YLVXDOHV & &RJQLFLyQ 1R WLHQH DOWHUDFLRQHV FRJQLWLYDV ,,, &RQWURO SRVWXUDO /D DOWHUDFLyQ GHO FRQWURO SRVWXUDO HV XQ IDFWRU LPSRUWDQWH TXH FRQWULEX\H D OD OLPLWDFLyQ GH ODV FDSDFLGDGHV IXQFLRQDOHV GH *HQLVH 'HVGH TXH UHJUHVy D FDVD KD WHQLGR YDULDV FDtGDV PLHQWUDV HVWDED HQ VHGHQWDFLyQ H LQFOLQiQGRVH SDUD OHYDQWDU DOJR R PLHQWUDV FDPLQDED $ (VFDOD GH HTXLOLEULR GH %HUJ $ XQ PHV GHO $&9 *HQLVH WLHQH XQD SXQWXDFLyQ GH GH HQ OD ((% VXV SXQWXDFLRQHV HQ ORV HOHPHQWRV HVSHFtILFRV VRQ ODV VLJXLHQWHV 3DVR GH VHGHVWDFLyQ D ELSHGHVWDFLyQ SXHGH SHUPDQHFHU HQ ELSHGHVWDFLyQ XWLOL]DQGR ODV PDQRV GHVSXpV GH YDULRV LQWHQWRV %LSHGHVWDFLyQ QHFHVLWD YDULRV LQWHQWRV SDUD ORJUDU OD SRVLFLyQ GXUDQWH V VLQ DSR\R 6HGHVWDFLyQ VLQ DSR\R SXHGH ORJUDU OD SRVLFLyQ VLQ ULHVJR \ FRQ VHJXULGDG GXUDQWH PLQ 3DVR GH ELSHGHVWDFLyQ D VHGHVWDFLyQ FRQWUROD HO GHVFHQVR XWLOL]DQGR ODV PDQRV 7UDVODGR SXHGH WUDVODGDUVH VLQ ULHVJR FRQ QHFHVLGDG GHILQLGD GH ODV PDQRV %LSHGHVWDFLyQ FRQ RMRV FHUUDGRV SXHGH PDQWHQHU OD SRVLFLyQ GXUDQWH V FRQ VXSHUYLVLyQ %LSHGHVWDFLyQ FRQ ORV SLHV MXQWRV QHFHVLWD D\XGD SDUD ORJUDU OD SRVLFLyQ QR SXHGH VRVWHQHUVH PiV GH V

$OFDQFH KDFLD DGHODQWH DOFDQFH KDFLD DGHODQWH SHUR QHFHVLWD VXSHUYLVLyQ ,QFOLQDFLyQ QR SXHGH ORJUDU OD ELSHGHVWDFLyQ \ QHFHVLWD VXSHUYLVLyQ DO LQWHQWDUOR *LUR SDUD JLUDU VREUH HO KRPEUR QHFHVLWD VXSHUYLVLyQ FXDQGR JLUD *LUR GH ƒ QHFHVLWD D\XGD PLHQWUDV JLUD &RQWDFWR FRQ HO EDQFR QHFHVLWD D\XGD SDUD HYLWDU FDHUVH QR SXHGH LQWHQWDUOR %LSHGHVWDFLyQ VREUH XQD H[WUHPLGDG SLHUGH HO HTXLOLEULR DO GDU XQ SDVR R DO SRQHUVH GH SLH %LSHGHVWDFLyQ HQ WDOyQ GHGR QR SXHGH LQWHQWDUOR R QHFHVLWD D\XGD SDUD HYLWDU FDHUVH % &RPSRQHQWHV GHO FRQWURO SRVWXUDO 6HGHVWDFLyQ

(TXLOLEULR HQ HVWDGR HVWDEOH HO HTXLOLEULR HQ HVWDGR HVWDEOH HQ VHGHVWDFLyQ HV UHODWLYDPHQWH VDWLVIDFWRULR 6X SHVR HVWi XQ SRFR GHVSOD]DGR KDFLD OD L]TXLHUGD SHUR PXHVWUD XQ EDODQFHR PtQLPR 6LQ HPEDUJR FXDQGR VX DWHQFLyQ VH GHVYtD SDUD UHVSRQGHU D SUHJXQWDV HO EDODQFHR DXPHQWD 3XHGH PDQWHQHU HO HTXLOLEULR HQ HVWDGR HVWDEOH HQ VHGHVWDFLyQ LQGHSHQGLHQWH FRQ ORV RMRV FHUUDGRV &XDQGR VH GHVSOD]D GH OD YHUWLFDO FRQ ORV RMRV FHUUDGRV QR SXHGH UHJUHVDU D XQD SRVLFLyQ YHUWLFDO VLPpWULFD OR TXH VXJLHUH SRVLEOH DOWHUDFLyQ GH ODV SULRSLRFHSFLRQHV GH OD YHUWLFDOLGDG (TXLOLEULR UHDFWLYR SXHGH UHFXSHUDUVH GH IRUPD LQGHSHQGLHQWH GH SHUWXUEDFLRQHV SHTXHxDV HQ WRGDV ODV GLUHFFLRQHV HQ VHGHVWDFLyQ 6LQ HPEDUJR HQ UHVSXHVWD D XQ GHVSOD]DPLHQWR FRQVLGHUDEOH GH VX ODGR SDUpWLFR QR SXHGH DOFDQ]DU DSR\R SDUD VRVWHQHUVH FRQ VX EUD]R SDUpWLFR \ WLHQH TXH VHU DWUDSDGD SDUD HYLWDU XQD FDtGD (TXLOLEULR SURDFWLYR WLHQH EXHQ HTXLOLEULR SURDFWLYR HQ VHGHVWDFLyQ \ SXHGH LQFOLQDUVH PiV GH ƒ OHYDQWDU FRVDV GHO VXHOR \ JLUDU VX FDEH]D \ HO WURQFR VLQ SHUGHU HO HTXLOLEULR %LSHGHVWDFLyQ (TXLOLEULR HQ HVWDGR HVWDEOH D XQ PHV GHO $&9 VX HTXLOLEULR HQ HVWDGR HVWDEOH HQ ELSHGHVWDFLyQ HVWi VLJQLILFDWLYDPHQWH DOWHUDGR 0DQWLHQH OD HVWDELOLGDG SHUR VyOR GXUDQWH XQRV PLQXWRV \ ORJUD OD ELSHGHVWDFLyQ VLPpWULFDPHQWH FRQ VX SHVR FDPELDGR D OD L]TXLHUGD &XDQGR HVWi GLVWUDtGD SLHUGH VX HTXLOLEULR KDFLD DWUiV \ UHTXLHUH D\XGD SDUD HYLWDU FDHUVH (O HTXLOLEULR HQ HVWDGR HVWDEOH QR FDPELD FXDQGR FLHUUD ORV RMRV OR TXH LQGLFD TXH QR GHSHQGH PXFKR GH OD YLVLyQ \ SXHGH XWLOL]DU DIHUHQFLDV VRPDWRVHQVRULDOHV \ YHVWLEXODUHV SDUD HO FRQWURO SRVWXUDO (TXLOLEULR UHDFWLYR QR SXHGH UHFXSHUDUVH GH OD SpUGLGD GHO HTXLOLEULR HQ GLUHFFLyQ KDFLD DGHODQWH R DWUiV XWLOL]DQGR XQD HVWUDWHJLD GH DSR\R ILMR \ QHFHVLWD D\XGD SDUD HYLWDU XQD FDtGD (Q UHVSXHVWD D OD SUXHED GH LQFOLQDFLyQ \ OLEHUDFLyQ *HQLVH GD XQ SDVR FRQ VX H[WUHPLGDG QR SDUpWLFD SHUR UHTXLHUH D\XGD SDUD OD UHFXSHUDFLyQ &XDQGR FDUJD HO SHVR VREUH OD H[WUHPLGDG SDUpWLFD SDUD GDU HO SDVR FRQ OD H[WUHPLGDG QR SDUpWLFD OD URGLOOD VH WHQVD HQ KLSHUH[WHQVLyQ SDUD HYLWDU HO FRODSVR GH OD H[WUHPLGDG SDUpWLFD 1R SXHGH GDU XQ SDVR VXILFLHQWHPHQWH UiSLGR FRQ OD H[WUHPLGDG SDUpWLFD SDUD HYLWDU XQD FDtGD (TXLOLEULR SURDFWLYR WLHQH GLILFXOWDG SDUD PDQWHQHU VX HTXLOLEULR GXUDQWH HO DOFDQFH KDFLD DGHODQWH \ UHTXLHUH D\XGD SDUD UHDOL]DU OD WDUHD 5HILHUH YDULDV FDtGDV DO LQFOLQDUVH SDUD DUUHPDQJDUVH HO SDQWDOyQ HQ ELSHGHVWDFLyQ AMPLE

Figura 11.17 ( Continuación )