Estimulação vestibular galvânica na reabilitação da instabilidade postural na doença de Parkinson

Abstract

Postural instability associated with Parkinson's disease (PD) has been associated with limited response to dopaminergic therapy. Galvanic Vestibular Stimulation (GVS) is a non-invasive and low-cost method that has been used to rehabilitate body balance through short-term electrical stimulation and low current in the mastoid bones, creating a dipole that stimulates the vestibulospinal tract. Objective: The objective was to evaluate the safety and balance response to GVS in patients with PD and postural instability treated at the Neurology clinic of Santa Casa de Misericórdia in Belo Horizonte, Brazil. Methods: As part of a comparative intragroup study to evaluate before and after the intervention, 25 patients with PD and postural instability in the ON phase were evaluated using the Berg Balance Scale (BBS), Time Up and Go test (TUG) and static posturography on the force platform. The intensity of the electrical current between the mastoids was progressively increased from 1.0 milliamps (mA) to 3.5 mA until the sixth session and then maintained until the eighth session. Stimulation time was progressively increased from 9 minutes in the first session to 30 minutes in the third session and then maintained until the eighth session. Results: Comparing the evaluations before and after GVS, the results showed improvement in BBS (p = 0.00001) and in TUG (p = 0.00003) scores. In posturography, an increase in the stability limit area (p = 0.026) and in the general balance index (p = 0.001) was observed. No participant had any complaints or side effects associated with the intervention. Conclusions: GVS was a useful and safe tool to improve postural instability in PD patients. In the current therapeutic context of managing postural instability associated with PD, GVS is an attractive option, considering its safety, possibility of home use and easy learning to manage the technique. It remains to be assessed whether the balance gain is maintained after GVS is discontinued.