Evidência científica e desenvolvimento tecnológico para neuropróteses motoras

Abstract

Motor neuroprostheses (MN) is an alternative assistive devices for patients with foot drop due to upper motor neuron lesion, such as stroke. Particularly because it allows orthotic effect and also training effect. The first one reflecting the direct improvement in tasks while using the MN and the second is related to a longer-lasting improvement while the device is not being used. Considering the context of health technology assessment and seeking to highlight the effects of MN for improving activities and participation in people after stroke, we present a systematic review published in the Cochrane Database of Systematic Reviews, and based on its findings was proposed the development of a prototype of an electrode system and garment compatible with a more efficient stimulation profile applicable to MN devices. The methodology was composed by two integrated items: (i) systematic review with meta-analysis; (ii) technological development of a prototype of an electrode system and garment applicable to MN. Based on proof of concept tests was structured a new configuration of electrodes designed to conform the area of common fibular nerve, proximal and distal motor points of the deep fibular nerve in the tibialis anterior muscle, and a structure of a garment based on measures of effectiveness and efficiency associated with wearability, the result of this work being a deposit of an invention patent at the INPI. The use of MN as an environmental facilitator in the home or community context does not appear to be more beneficial than other assistive devices for improving activities involving limbs, exercise capacity, and participation scale of health-related quality of life, with no potential for increase the number of falls or serious adverse events related to the intervention, although MN is associated with a higher number of dropouts related to its use when compared to ankle-foot orthosis. In the technological development scope, the developed configuration of electrodes promoted a more efficient ankle dorsiflexion, with greater strength production, resistance to fatigue and not associated with greater discomfort, as well as the integration of these in a garment gave the system wearbility, enabling allocation of electrodes in the target neuromuscular structures and repeatability in user application in successive uses of electrostimulation.