Efeito do uso de pistas externas nos parâmetros de marcha de pacientes com doença de Parkinson: Revisão sistemática
Arquivos
Data
2014
Autores
Rocha, Priscila Alves 
Orientadores
Ferraz, Henrique Ballalai
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A doenca de Parkinson e uma das doencas neurologicas mais prevalentes. Diversos deficits motores estao presentes nestes pacientes, entre eles os disturbios da marcha e equilibrio. Alem das terapias convencionais, tem se utilizado com frequencia, pistas (tambem chamados de feedback extrinseco) para melhora destes deficits. Objetivos: Avaliar a efetividade e seguranca do uso de pistas na marcha de pacientes com Doenca de Parkinson. Assim como verificar se a mudanca na marcha provocada auxilia na melhora da qualidade de vida e do desempenho psicomotor, e diminuicao do freezing. Por fim, com os objetivos anteriores respondidos, analisar qual tipo de pista externa provoca ganhos mais expressivos em todos os desfechos analisados. Metodos de busca: As bases de dados eletronicas analisadas foram: Cochrane Library, Pubmed, Embase, Lilacs, Pedro, e Sumsearch. Tambem foram analisados artigos das referencias bibliograficas dos artigos coletados, assim como busca manual nas Revistas Movement Disorders e Physical Therapy, alem de anais de congressos principalmente da Movement Disorders Society. As seguintes palavras chaves foram utilizadas: Parkinson disease, feedback, biofeedback, neurofeedback, psychology biofeedback, cue, cues, cueing, rehabilitation, physical therapy, physiotherapy, exercise, locomotion, gait, neurologic gait disorders, optical flow field, visual, auditory, sensory, tactile. Criterios de inclusao: Ensaios clinicos randomizados e quasi randomizados que analisaram marcha, freezing, qualidade de vida e desempenho psicomotor foram analisados. Coleta e analise de dados: Os dados destes estudos foram analisados por meio de um formulario padronizado por dois revisores. Resultados: Dos 259 artigos localizados, apenas sete estudos se enquadraram nos criterios de inclusao e de qualidade metodologica desta revisao. Deste total, dois estudos utilizaram pistas visuais, dois pistas auditivas, um analisou o uso de instrucoes verbais, um utilizou pistas combinadas e por fim, um utilizou pistas sensoriais (proprioceptivas). Em geral, o uso de pistas resultou em melhoras no comprimento do passo (p < 0,0001), velocidade (p < 0,00001), cadencia (p < 0,001), comprimento da passada (p < 0,00001). As pistas visuais provocaram melhorias significantes na velocidade (p < 0,00001), cadencia (p < 0,00001) e comprimento do passo (p = 0,0004), enquanto as auditivas foram efetivas no aumento do comprimento do passo (p = 0,03) e velocidade (p < 0,00001); o estudo incluido que avaliou o uso da instrucao verbal apenas analisou comprimento do passo, porem, esta intervencao nao mostrou diferenca estatisticamente significante para este desfecho (p = 0,16). A pista sensorial (proprioceptiva) mostrou beneficios significantes na velocidade (p = 0,01), cadencia e comprimento da passada (p < 0,00001), enquanto que com o uso de pistas combinadas (visual + auditiva) houve maiores ganhos na UPDRS III (p = 0,009) do que na velocidade (p = 0,01). Conclusao: Esta revisao sistematica apresenta nivel de evidencia 1A, com base na classificacao de oOxford Centre for Evidence-based Medicineo. Conclui-se que o uso de pistas externas e efetivo para a melhora dos parametros de marcha de pacientes com Doenca de Parkinson, havendo melhora do freezing, do desempenho psicomotor avaliados pelo FOGQ e UPDRS III, respectivamente
Parkinson's disease (PD) is one of the most prevalent neurological diseases. Several motor deficits are present in patients with this disease, including gait and balance disturbances. In addition to onventional therapies, it has been used frequently in the current studies, cues (also called extrinsic feedback) to improve gait and balance in PD patients.Objectives: Evaluate the effectiveness and safety of using cues on gait in patients with PD. As well as verify if this improvement on gait generates increase in quality of life, decrease freezing and improve psychomotor performance on this population. Finally, with the previous goals answered, to analyze which type of cues cause more significant gains in all outcomes assessed. Search methods: Electronic databases analyzed: Cochrane Library, Pubmed, Embase, Lilacs, Pedro and Sumsearch. It was also analyzed the articles references, as well as manual search on Movement Disorders and Physical Therapy journals, in addition to the annals of the Movement Disorders Society. The following key words were used: Parkinson disease, feedback, biofeedback, neurofeedback, biofeedback, psychology cue, cues, cueing, rehabilitation, physical therapy, physiotherapy, exercise, locomotion, gait, gait disorders, neurologic optical flow field, visual, auditory, sensory, proprioceptive and tactile. Inclusion criteria: Randomized and quasi randomized clinical trials that assessed gait, freezing, quality of life and psychomotor performance were analyzed. Data collection and analysis: two reviewers analyzed the data with a standardized form. Results: Of 259 articles collected, just 07 fit the inclusion and methodological quality criteria of this review. Of this total, two studies used visual cues, two auditory cues, one used verbal instructions, one used combined cues and finally, one used sensory cues (proprioceptive). In general, the use of cues led improves with statistically significant difference in step length (p < 0,0001), speed (p < 0,00001), cadence (p < 0,001), stride length (p < 0,00001). Moreover, visual cues were most effective in improving speed (p < 0,00001), cadence (p < 0,00001) and step length (p = 0,0004), while the auditory cues cause more impact in step length (p = 0,03) and speed (p < 0,00001). Verbal instruction did not show statistically significant difference for any outcome (p = 0,16). The sensory (proprioceptive) cues showed significant improvements in speed (p = 0,01), cadence and stride length (p < 0,00001), while with combined cues (visual + auditory) there was greater gains in UPDRS III (p = 0,009) than in speed (p = 0,01). Conclusion: this systematic review has evidence level 1A based on the “Oxford Centre for Evidence-based Medicine”. It was proved that the use of external cues is effective to improve gait parameters of patients with Parkinson's disease, with improvements on freezing and psychomotor performance, evaluated by FOGQ and UPDRS III, respectively.
Parkinson's disease (PD) is one of the most prevalent neurological diseases. Several motor deficits are present in patients with this disease, including gait and balance disturbances. In addition to onventional therapies, it has been used frequently in the current studies, cues (also called extrinsic feedback) to improve gait and balance in PD patients.Objectives: Evaluate the effectiveness and safety of using cues on gait in patients with PD. As well as verify if this improvement on gait generates increase in quality of life, decrease freezing and improve psychomotor performance on this population. Finally, with the previous goals answered, to analyze which type of cues cause more significant gains in all outcomes assessed. Search methods: Electronic databases analyzed: Cochrane Library, Pubmed, Embase, Lilacs, Pedro and Sumsearch. It was also analyzed the articles references, as well as manual search on Movement Disorders and Physical Therapy journals, in addition to the annals of the Movement Disorders Society. The following key words were used: Parkinson disease, feedback, biofeedback, neurofeedback, biofeedback, psychology cue, cues, cueing, rehabilitation, physical therapy, physiotherapy, exercise, locomotion, gait, gait disorders, neurologic optical flow field, visual, auditory, sensory, proprioceptive and tactile. Inclusion criteria: Randomized and quasi randomized clinical trials that assessed gait, freezing, quality of life and psychomotor performance were analyzed. Data collection and analysis: two reviewers analyzed the data with a standardized form. Results: Of 259 articles collected, just 07 fit the inclusion and methodological quality criteria of this review. Of this total, two studies used visual cues, two auditory cues, one used verbal instructions, one used combined cues and finally, one used sensory cues (proprioceptive). In general, the use of cues led improves with statistically significant difference in step length (p < 0,0001), speed (p < 0,00001), cadence (p < 0,001), stride length (p < 0,00001). Moreover, visual cues were most effective in improving speed (p < 0,00001), cadence (p < 0,00001) and step length (p = 0,0004), while the auditory cues cause more impact in step length (p = 0,03) and speed (p < 0,00001). Verbal instruction did not show statistically significant difference for any outcome (p = 0,16). The sensory (proprioceptive) cues showed significant improvements in speed (p = 0,01), cadence and stride length (p < 0,00001), while with combined cues (visual + auditory) there was greater gains in UPDRS III (p = 0,009) than in speed (p = 0,01). Conclusion: this systematic review has evidence level 1A based on the “Oxford Centre for Evidence-based Medicine”. It was proved that the use of external cues is effective to improve gait parameters of patients with Parkinson's disease, with improvements on freezing and psychomotor performance, evaluated by FOGQ and UPDRS III, respectively.
Descrição
Citação
ROCHA, Priscila Alves. Efeito do uso de pistas externas nos parâmetros de marcha de pacientes com doença de Parkinson: revisão sistemática. 2014. 97 f. Dissertação (Mestrado em Ciências) – Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo. 2014.