Data de recebimento do artigo: 6/11/00 -Data de aprovação: 27/12/00 RESUMO O SNC possui uma rede neural complexa, com células altamente especializadas, que fazem milhares de conexões a todo momento e determinam a sensibilidade e as ações motoras, traduzindo-as em comportamento. Na presença de lesões, há um desarranjo nesta rede neural e o SNC inicia seus processos de reorganização e regeneração. A plasticidade neural refere-se à capacidade que o SN possui em alterar algumas das suas propriedades morfológicas e funcionais em resposta às alterações do ambiente. A análise dos aspectos plásticos do SNC permite-nos relacioná-los a vários fatores, como a influência do meio ambiente, o estado emocional, o nível cognitivo, entre outros, que interferem direta ou indiretamente na plasticidade do SNC e, conseqüentemente, na reabilitação do paciente neurológico. Assim, por meio da revisão da literatura, procuramos uma fundamentação teórica, a qual trará bases para a prática clínica, buscando uma nova visão sobre as perspectivas de reabilitação do paciente neurológico adulto. UNITERMOS Plasticidade neural. Lesão no SNC. Ambiente terapêutico. Reabilitação física. Adulto.

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Gait initiation is a daily challenge even for healthy individuals as it requires the timely coupling between the automatic anticipatory postural adjustment (APA) and the voluntary step according to the context. Modulation of this motor event has been thought to involve higher level brain control, including cognitive inhibitory circuitries. Despite the known participation of the supplementary motor area (SMA) in the modulation of some parameters of APA, the participation of areas controlling inhibition during gait initiation still needs to be investigated. In this study, the hemodynamic responses of the SMA and dorsolateral prefrontal cortex (DLPFC) were assessed using functional near-infrared spectroscopy (fNIRS) during a gait initiation task under cognitive conflict to select the foot to step (congruent [CON] and incongruent [INC] conditions). The older group (OG) showed worse inhibitory control than the young group (YG) along with more impairments in APA parameters. OG also had a lower amplitude of hemodynamic responses in both areas than YG in the INC. The INC increased the correlation between SMA and DLPFC only in the YG. Aging seems to impair the interaction between the hemodynamic responses of SMA and DLPFC, which influences APA performance in gait initiation under cognitive conflict.

In individuals with Parkinson's disease (PD), the medication induces different and inconsistent results in the spatiotemporal parameters of gait, making it difficult to understand its effects on gait. As spatiotemporal gait parameters have been reported to be affected by gait speed, it is essential to consider the gait speed when studying walking biomechanics to interpret the results better when comparing the gait pattern of different conditions. Since the medication alters the self-selected gait speed of individuals with PD, this study analysed whether the change in gait speed can explain the selective effects of L-DOPA on the spatiotemporal parameters of gait in individuals with PD. We analysed the spatiotemporal gait parameters at the self-selected speed of 22 individuals with PD under ON and OFF states of L-DOPA medication. Bayesian mediation analysis evaluated which gait variables were affected by the medication state and checked if those effects were mediated by speed changes induced by medication. The gait speed was significantly higher among ON compared with OFF medication. All the spatiotemporal parameters of the gait were mediated by speed, with proportions of mediation close to 1 (effect entirely explained by speed changes). Our results show that a change in gait speed better explains