Zvinonyanya Kukosha muChikamu: 2026 PAS Congress

Kubva panzira dzekutarisira: Kukanganisika kwekufamba kwemuviri muchirwere cheParkinson

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Munguva yeMusangano wechitanhatu wePan American weMDS, musangano wakakwana wakatarisana ne "Kubatanidza maturusi edhijitari mukuongorora nekurapa matambudziko ekufamba muchirwere cheParkinson." Chirongwa ichi chakaongorora nzira nehunyanzvi hwetekinoroji dziri kubuda mukugadzirisa patsva maitiro ekurapa nekutsvaga matambudziko ekufamba. Musangano uyu waive nechinangwa chekuzadzisa zvinangwa zvitatu zvakakosha zvekudzidza, zvakapihwa naDr. Gonzalo Revuelta, Dr. Martina Mancini, naDr. Tamine Capato, uye zvakatungamirwa naDr. Catalina Cerquera naGonzalo Revuelta.

Session Faculty Dr. Gonzalo Revuelta, Dr. Martina Mancini, Dr. Tamine Capato, uye Dr. Catalina Cerquera (sachigaro).

Chekutanga, Dr. Revuelta vakatsanangura nzira dzekurapa dzinokonzera kusashanda zvakanaka kwekufamba uye kuomesa kufamba (FOG) muchirwere cheParkinson (PD), vachinyanya kusimbisa zvinhu zvisiri zvedopaminergic. Vakasimbisa kuti nzira dzeFOG dzakaoma uye dzakasiyana, dzine mipiro kubva kumagetsi, uropi, uye limbic networks. Kurapa kunogona kugadzirwa kuti kunange kusashanda zvakanaka kwenetwork ne neuromodulation, rehabilitation, kana kushandiswa kwe neurotransmitters.

Dambudziko guru mu network yekufambisa mafambiro emagetsi kushaikwa kwekufamba otomatiki, kunonyanya kufungidzirwa semhedzisiro ye dopaminergic denervation. Maitiro ekudzorera kushaya kudzora kwemaitiro akajairika anosanganisira kuchinja kuenda kune kutonga kwekufamba kwemafambiro kwekuzvidira kana kutungamirirwa nechinangwa. Kunyange zvazvo nzira iyi yekudzorera ichigona kushanda pakutanga, haishande zvakanaka, inononoka, uye inogona kukanganiswa nemutoro wekunze, unogona kuva wekufambisa mafambiro emagetsi, wekuziva, kana we limbic, uye unogona kutungamira kuFOG.

Sezvo munda uyu uchifambira mberi uchienda kumatanho ekukurudzira nekukurumidza uye maitiro ekugadzirisa tsinga, kutarisisa kwakasarudzika, uye kugadzirisa, zvakakosha kuongorora mhedzisiro yemaitiro eFOG uye mhedzisiro ye network iri pasi. Zvidzidzo zveramangwana zvinofanirwa kubatanidza mhedzisiro ye neuroimaging uye mhedzisiro ye neurophysiological neongororo dzakajairwa dzemaitiro kuti zvione kuti ndeapi maitiro e cortical anoda kugadziriswa, pakupedzisira nechinangwa chekuvandudza kugadzirisa kwe compensatory uye kudzorera otomatiki kufamba.

Chechipiri, Dr. Mancini vakaongorora mashandiro, zvipingamupinyi, uye gwara remangwana rematekinoroji anopfekwa uye zviratidzo zvekufamba kwedhijitari muPD.

Ongororo yakaitwa panguva chaiyo yakaratidza musiyano mukuru: kunyangwe 78% yevanachiremba vachiziva miganhu yekuongorora kwekiriniki kwekufamba (MDS-UPDRS, kucherechedza kupfupi kwekiriniki, snapshots), 61% vakataura kuti havasati vashandisa zvipfeko zvinopfekwa pakuongorora kufamba. Izvi zvinoratidza kudiwa kwezvishandiso zvedhijitari zvinowanikwa nyore nyore, zvakasimbiswa, uye zvakajairika.

Tsvagiridzo yemakore makumi maviri apfuura pamusoro pekufamba yakaratidza zvakawanikwa zvinovimbisa mukutsigira kuongororwa kwechirwere nekupa matanho ekufamba anokwanisa kusiyanisa kufamba kwakanaka nekwemunhu ane PD kana REM sleep behavior disorders (RBD) isati yatanga kurapwa, uye kugona kubata, nemhedzisiro yakakura kupfuura huwandu hwekiriniki, shanduko dzinokonzerwa nekupindira uye kutarisa shanduko dzekufamba nekufamba nekufamba kwechirwere. Pasinei neuchapupu hwakasimba uhwu, munda uyu wagara usina gwara rakajairika, zvichikonzera kusiyana kukuru kwemaitiro anokonzerwa nekusiyana kwemidziyo, nzvimbo, uye zvinangwa zvekudzidza.

Pepa rekubvumirana richangoburwa rakapa gwaro remitemo mishoma yekuongorora muzvipatara/murabhoritari uye munzvimbo chaiyo, zvichiratidza danho rakakosha rekubatana, kunyangwe kugamuchirwa kwakapararira kuchiri kudiwa kuti ubatanidze zvizere mhedzisiro yekufamba mumiedzo yekiriniki.

Mukati meiyi nzira shoma, mienzaniso kubva muzvidzidzo zviri kuenderera mberi inoratidza kukosha kwemuviri wepamusoro, uye kunyanya kuderedzwa kweruoko panguva yekufamba, kusiyanisa pakati pePD isati yatanga kurapwa uye kudzora hutano. Kutendeuka paunenge uchifamba ndeimwe yenzvimbo dzinonyanya kukanganiswa dzekufamba muvanhu vane PD iri pakati nepakati. Zvakawanikwa zvechokwadi pakufamba zvinoratidza kunzwisisika kwakanyanya kupfuura kuongororwa kwekiriniki/kurabhoritari, nemukana wakasiyana wekuongorora kushanduka kwekufamba mukati mezuva uye mazuva akawanda. Zvisinei, matambudziko ekubata nedata iri rinoshanduka zvakanyanya uye rine mativi akawanda akaongororwa.

Chekupedzisira, asi chisiri chidiki, akasimbisa kukosha kwekuti tekinoroji nemaalgorithms zvinyatso simbiswa kuti zvishandiswe kune vanhu vane PD.

Chechitatu, Dr. Capato vakakurukura humbowo huripo hunotsigira kupindira kusiri kwemishonga, kusanganisira cueing, tekinoroji yedhijitari, uye kugadziriswa kuburikidza nerobhoti, kuti vawedzere kufamba uye kuenzana muPD. Vakasimbisa kukosha kwephysiotherapy mukugadzirisa matambudziko ekufamba muzvikamu zvese zvechirwere, kusanganisira FOG.

Kunyange zvazvo paine humbowo hwakasimba hwekuti kurovedza muviri inzvimbo inokosha yekuongorora, kuziva mwero wakakodzera wekurovedza muviri unodiwa kuti uvandudze FOG uye ubatsire chirwere ichi kwakakosha. Zvirongwa zvekugadzirisa kufamba zvakasarudzwa kuti zvive zvakakosha, zvichitarisa padanho rakakodzera, chiyero, uye nguva yekurovedza muviri.

Mirayiridzo yekurapa mafambiro emuviri yePD inoratidza mhedzisiro yakanaka yekuvandudzwa kwekufamba kwetsinga dzetsinga pamaitiro ese ekufamba, kuvandudza kufamba (nhanho yenhanho, kureba kwenhanho, kumhanya, kutendeuka, uye kufamba kwemuviri) uye kuderedza zviitiko zveFOG uye njodzi yekudonha. Kushandiswa kwenzira dzekubhadhara, dzinowanzo tungamirirwa nenyanzvi dzekurapa mafambiro, kwave chinhu chakakosha pakuvandudzwa kwekufamba muPD, sezvo kurapwa kwemishonga kwakajairika kusingakwani kuderedza kushomeka kwekufamba uye kuenzana.

Pamusoro pezvo, mienzaniso yenzira dzekuripa mari yekukunda FOG yakapihwa. Kufambira mberi mune tekinoroji uye tekinoroji yekubatsira, semuenzaniso, zvishandiso zve laser zvinoonekwa, metronomes, maapplication enharembozha, exergames, virtual reality, mapuratifomu edhijitari, uye robotics, zvakakurukurwa, zvichitsanangura kuti vari kuchinja sei munda wekugadzirisa kufamba muPD. Kazhinji, ramangwana rekugadzirisa kufamba muPD rine tariro huru, richitungamirirwa nekufambira mberi kwetekinoroji nekukurumidza, kupindira kwakagadzirirwa munhu, uye kunzwisisa kwakadzama kwe neuroplasticity. Nzira dzekuvandudza nzira itsva dziri kuchinja chinangwa kubva pakungogadzirisa zviratidzo kuenda pakuvandudza kufamba.

Muchidimbu, kubatana pakati pekuchinja kwenetwork ne neurotransmitter kuri kujeka, zvichibvumira kuti zvinangwa zvekurapa zvibude. Sezvo zviyero zve digital zvekufamba zvichibva pakupfeka zviri kushandiswa zvakanyanya uye zvichitenderwa, zvinogona kuwanikwa munguva pfupi kuvanachiremba nevarapi vemuviri pasi rese. Sezvo nzira dzekuongorora dzichivandudzika kuti dzibate kuoma kweFOG uye nzira dzekugadzirisa dzichiri kuramba dzichikura, nzira yekuenda kune nzira dzekurapa dzeFOG dziri pedyo. Kupindira kwakajairika kwekurapa kunovavarira kudzoreredza otomatiki (dopaminergic replacement, deep brain stimulation ye deep locomotor centers, kana dual task gait training) kana kuvandudza mhinduro dzemari (noradrenergic kana cholinergic replacement ichitarisa kutarisisa/executive function, kana cueing strategies). Zvidzidzo zveramangwana zvinofanira kuongorora kana neuromodulation inogona kunanga kusashanda zvakanaka kwenetwork kuti iwedzere mari yekugadzirisa, kuderedza maradaptive adaptation, kana kudzorera gait automation.

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