Limite de estabilidade e controle postural em meninos com Distrofia Muscular de Duchenne
Data
2022-10-24
Autores
Futema, Eduardo [UNIFESP]
Orientadores
Sá, Cristina dos Santos Cardoso de [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
INTRODUÇÃO: A Distrofia Muscular de Duchenne (DMD) é uma doença
genética de herança recessiva ligada ao cromossomo X, devido a mutação no gene da
proteína distrofina caracterizada por fraqueza muscular progressiva, associada à perda de
fibra muscular. Conforme a doença progride, surgem algumas alterações como,
deformidades osteoarticulares e dificuldades na manutenção do equilíbrio corporal
estático e dinâmico. OBJETIVO: Avaliar o controle postural de meninos com DMD
deambuladores, e o papel das informações sensoriais nesse controle, comparando com
meninos sadios. MÉTODO: Trata-se de estudo observacional, descritivo, analítico e
transversal, constituído de 12 meninos com DMD (7 a 16 anos) classificados na escala de
Vignos de 1 a 6 e grupo controle com 12 meninos sadios (7 a 16 anos). Os participantes
foram alocados em dois Grupos: Meninos com DMD (Grupo DMD) e controle com
meninos sadios (Grupo C). Os instrumentos de classificação foram: Escala Vignos de
estadiamento da doença (Vignos), Miniexame do Estado Mental (MEEM – avaliação
cognitiva). A avaliação do controle postural foi realizada por meio da plataforma de
pressão Footwork da empresa AMD, em 4 condições experimentais: olhos abertos (OA),
olhos fechados (OF), fluência verbal (FV) e rotação cervical (RC). As principais variáveis
analisadas foram: a trajetória do centro de pressão (COP), área de elipse do COP, índice
de simetria, Limite de Estabilidade (LE) e a Reserva Funcional do Equilíbrio Corporal
(RFE). RESULTADOS: O grupo DMD apresentou resultados inferiores para todas as
variáveis do controle postural, exceto para o deslocamento do COP-AP e alinhamento que
não revelou diferença entre os grupos. Para o Índice de Simetria foram encontradas
diferenças significativas na interação entre as condições OA e OF, FV e RC. A RFE (%)
apresentou diferença significativa apenas na comparação entre grupos, com o Grupo
DMD apresentando menor RFE. Para a variável da Área do Limite de Estabilidade (cm2
),
verificou-se diferença significativa entre os Grupos (p=0,046), evidenciando maior
dificuldade nos meninos com DMD em mover-se voluntariamente o seu centro de
pressão. CONCLUSÃO: O limite de Estabilidade está prejudicado nos meninos com
DMD afetando consequentemente a Reserva Funcional do Equilíbrio que também está
reduzida nesses meninos, porém as diversas condições sensoriais analisadas não alteraram
significativamente o controle postural nos meninos do grupo DMD.
INTRODUCTION: Duchenne Muscular Dystrophy (DMD) is a genetic disease of recessive inheritance linked to the X chromosome, due to mutation in the dystrophin protein gene characterized by progressive muscle weakness, associated with loss of muscle fiber. As the disease progresses, some changes appear, such as osteoarticular deformities and difficulties in maintaining static and dynamic body balance. OBJECTIVE: To evaluate the postural control of ambulatory boys with DMD, and the role of sensory information in this control, comparing it with healthy boys. METHOD: This is an observational, descriptive, analytical and cross-sectional study, consisting of 12 boys with DMD (7 to 16 years old) classified on the Vignos scale from 1 to 6 and a control group with 12 healthy boys (7 to 16 years old). Participants were allocated into two groups: Boys with DMD (DMD Group) and control with healthy boys (Group C). The classification instruments were: Vignos Disease Staging Scale (Vignos), MiniMental State Examination (MMSE – cognitive assessment). The assessment of postural control was performed using the Footwork pressure platform from AMD, in 4 experimental conditions: eyes open (OA), eyes closed (OF), verbal fluency (FV) and cervical rotation (CR). The main variables analyzed were: the trajectory of the center of pressure (COP), ellipse area of the COP, symmetry index, Limit of Stability (LE) and the Functional Reserve of Body Balance (RFE). RESULTS: The DMD group showed lower results for all postural control variables, except for the COP-AP displacement and alignment, which did not reveal any difference between the groups. For the Symmetry Index, significant differences were found in the interaction between the conditions OA and OF, FV and RC. The RFE (%) showed a significant difference only in the comparison between groups, with the DMD Group presenting lower RFE. For the variable of the Stability Limit Area (cm2), there was a significant difference between the groups (p=0.046), showing greater difficulty in boys with DMD in voluntarily moving their center of pressure. CONCLUSION: The stability limit is impaired in boys with DMD, consequently affecting the Functional Balance Reserve, which is also reduced in these boys, but the different sensory conditions analyzed did not significantly alter postural control in boys in the DMD group.
INTRODUCTION: Duchenne Muscular Dystrophy (DMD) is a genetic disease of recessive inheritance linked to the X chromosome, due to mutation in the dystrophin protein gene characterized by progressive muscle weakness, associated with loss of muscle fiber. As the disease progresses, some changes appear, such as osteoarticular deformities and difficulties in maintaining static and dynamic body balance. OBJECTIVE: To evaluate the postural control of ambulatory boys with DMD, and the role of sensory information in this control, comparing it with healthy boys. METHOD: This is an observational, descriptive, analytical and cross-sectional study, consisting of 12 boys with DMD (7 to 16 years old) classified on the Vignos scale from 1 to 6 and a control group with 12 healthy boys (7 to 16 years old). Participants were allocated into two groups: Boys with DMD (DMD Group) and control with healthy boys (Group C). The classification instruments were: Vignos Disease Staging Scale (Vignos), MiniMental State Examination (MMSE – cognitive assessment). The assessment of postural control was performed using the Footwork pressure platform from AMD, in 4 experimental conditions: eyes open (OA), eyes closed (OF), verbal fluency (FV) and cervical rotation (CR). The main variables analyzed were: the trajectory of the center of pressure (COP), ellipse area of the COP, symmetry index, Limit of Stability (LE) and the Functional Reserve of Body Balance (RFE). RESULTS: The DMD group showed lower results for all postural control variables, except for the COP-AP displacement and alignment, which did not reveal any difference between the groups. For the Symmetry Index, significant differences were found in the interaction between the conditions OA and OF, FV and RC. The RFE (%) showed a significant difference only in the comparison between groups, with the DMD Group presenting lower RFE. For the variable of the Stability Limit Area (cm2), there was a significant difference between the groups (p=0.046), showing greater difficulty in boys with DMD in voluntarily moving their center of pressure. CONCLUSION: The stability limit is impaired in boys with DMD, consequently affecting the Functional Balance Reserve, which is also reduced in these boys, but the different sensory conditions analyzed did not significantly alter postural control in boys in the DMD group.
Descrição
Citação
FUTEMA, Eduardo. Limite de estabilidade e controle postural em meninos com Distrofia Muscular de Duchenne. 2022. 68 f. Dissertação (Mestrado Interdisciplinar em Ciências da Saúde) - Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, Santos, 2022.