Postural automatisms and biomechanics of gait initiation and obstacle negotiation in parkinson’s disease : characterization and effects of different interventions

A doença de Parkinson (DP) é uma doença neurodegenerativa relacionada à perda da independência funcional, com fenômenos motores, como rigidez, desequilíbrio e alterações na marcha. Os automatismos posturais, incluindo os ajustes posturais antecipatórios (APA) e compensatórios (CPA) são essenciais para o equilíbrio em resposta a uma perturbação e seu uso eficiente pode reduzir a ocorrência de quedas em tarefas cotidianas, como iniciação da marcha e negociação de obstáculos. Evidências apontam os benefícios de programas de exercícios na melhora da locomoção e controle postural na DP, entretanto, poucos estudos investigaram os efeitos sobre os automatismos posturais. Assim, a presente dissertação tem o objetivo de caracterizar as estratégias de automatismos posturais e comportamento motor relacionados à iniciação da marcha e negociação de obstáculos de pessoas com DP e comparar os efeitos de três programas de treinamento sobre esses parâmetros. No capítulo I é feita a apresentação geral e contextualização do estudo. No capítulo II é apresentada uma revisão de literatura, com informações compiladas sobre a DP, os automatismos posturais, a locomoção e como diferentes intervenções podem auxiliar na melhora dos parâmetros alterados. As lacunas identificadas na literatura motivaram a escrita de dois estudos originais. Os objetivos dos estudos foram: 1) analisar e comparar os ajustes posturais e os parâmetros biomecânicos durante a iniciação da marcha e negociação de obstáculos de pessoas com DP rígido-acinética e hipercinética; e 2) analisar e comparar os efeitos de três programas baseados em exercício físico (dança, exercícios em água funda e caminhada Nórdica) sobre os ajustes posturais e os parâmetros biomecânicos na iniciação da marcha e negociação de obstáculos em pessoas com DP. No estudo 1, foram avaliadas, de forma transversal, pessoas com DP divididas por subtipos clínicos (rígidos-acinéticos e hipercinéticos). Para o estudo 2, um ensaio clínico, estes sujeitos foram randomizados em três grupos de intervenção de 22 sessões, sendo avaliados antes e depois. Em ambos os estudos as avaliações incluíram variáveis eletromiográficas, cinéticas e cinemáticas. No estudo I, observamos que o grupo rígido-acinético apresentou maior comprometimento neuromotor, refletido por menor ação antecipatória e compensatória de músculos estabilizadores, menor deslocamento do centro de pressão, maior tempo de duplo apoio e menores comprimento e altura de passo durante as tarefas. Além disso, no estudo II as três intervenções mostraram melhoras nos parâmetros avaliados, sendo mais evidentes nos parâmetros espaço-temporais e músculos de tronco para exercícios em água funda e caminhada Nórdica, enquanto que a Dança promoveu melhores resultados na ação dos músculos de quadril. Nossos resultados são importantes para entender as diferenças no controle motor de pacientes com diferentes manifestações clínicas da DP e para auxiliar na prescrição de programas terapêuticos. Ainda, sugerimos que as três intervenções propostas possuem potencial para a manutenção e melhora neuromotora de pessoas com DP.Parkinson's disease (PD) is a neurodegenerative disease related to loss of functional independence, with motor phenomena such as rigidity, imbalance and changes in gait. Postural automatisms, including anticipatory (APA) and compensatory (CPA) postural adjustments are essential for balance in response to a disturbance and their effective use can reduce the occurrence of falls in everyday tasks, such as gait initiation and obstacle negotiation. Evidence points to the benefits of exercise programs in improving locomotion and postural control in PD, however, few studies have investigated the effects on postural automatisms. Thus, the present dissertation aims to characterize the strategies of postural automatisms and motor behavior related to the gait initiation and obstacle negotiation in people with PD and to compare the effects of three training programs on these parameters. Chapter I presents the general presentation and context of the study. Chapter II presents a literature review, with information compiled about PD, postural automatisms, locomotion and how different interventions can help to improve altered parameters. The gaps identified in the literature motivated the writing of two original studies. The aims of the studies were: 1) to analyze and compare postural adjustments to biomechanical parameters during gait initiation and obstacle negotiation in people with akinetic-rigid (AK-R) and hyperkinetic (HYP) PD; and 2) to analyze and compare the effects of three programs based on physical exercise (Brazilian dance, deep water exercises and Nordic walking) on postural adjustments and biomechanical parameters in gait initiation and obstacle negotiation in people with PD. In study 1, people with PD divided by clinical subtypes (AK-R and HYP) were evaluated in a cross-sectional research. . For study 2, a clinical trial, these subjects were randomized into three intervention groups of 22 sessions, being assessed pre and post. In both studies, evaluations included electromyographic, kinetic and kinematic variables. In study I, we observed that the AK-R group showed greater neuromotor impairment, reflected by less anticipatory and compensatory action of stabilizing muscles, less displacement of the center of pressure, longer double support time and shorter step length and height during tasks. Furthermore, in study II, the three interventions showed improvements in the parameters evaluated, being more evident in spatiotemporal parameters and trunk muscles for deep water exercises and Nordic walking, while dance promoted better results in the action of the hip muscles. Our results are important to understand the differences in motor control of patients with different clinical manifestations of PD and to assist in the prescription of therapeutic programs. In addition, we suggest that the three proposed interventions have the potential to maintain and improve neuromotor performance in people with PD

Efeitos agudos da aplicação de bandagens funcionais no membro inferior sobre variáveis cinéticas e neuromusculares de mulheres com joelho valgo

Na prática fisioterapêutica, pressupõe-se que alterações posturais do membro inferior influenciam funcionalmente os demais complexos articulares. Entretanto, a literatura sobre a relação entre desalinhamentos estáticos e dinâmicos do joelho ainda é escassa e inconclusiva. Dentre as técnicas populares na Fisioterapia, destaca-se a aplicação da bandagem elástica, cujos efeitos positivos têm sido observados clinicamente, porém com pouca comprovação científica. O objetivo deste estudo foi avaliar os efeitos agudos da aplicação de bandagens funcionais no joelho ou no pé sobre a atividade eletromiográfica de músculos do membro inferior e a distribuição da pressão plantar de mulheres com joelho valgo durante a subida e descida de um degrau. A amostra foi composta por seis mulheres. Foram coletados dados eletromiográficos dos músculos Glúteo Médio, Tensor da Fáscia Lata, Vasto Lateral e Vasto Medial, em três situações: (1) sem bandagem, (2) bandagem no joelho, e (3) bandagem no pé, durante a subida e descida no degrau. Sobre o degrau foi colocada uma plataforma de pressão plantar, buscando coletar o deslocamento do centro de pressão (CP) durante a tarefa. O sinal eletromiográfico foi processado para obtenção da raiz quadrada da média (RMS) e normalizado pela contração voluntária máxima. Realizou-se ANOVA para medidas repetidas para verificar a diferença da atividade elétrica dos músculos envolvidos e deslocamento do CP em cada situação, e post hoc LSD para comparação múltipla com correção do intervalo de confiança, com p ≤ 0,05. Não foi encontrada diferença significativa entre os valores RMS de músculos do quadril e joelho a partir da aplicação das bandagens. O deslocamento do CP também parece não ter sido afetado pela utilização da bandagem funcional. Os resultados indicam que para a tarefa executada, o uso de bandagem funcional para correção articular não afeta significativamente as variáveis estudadas

Effects of mental fatigue on reaction time in sportsmen

Mental fatigue (MF) has been defined as a psychobiological state commonly caused by prolonged periods of demanding cognitive activity. However, the differences between women and men in their reaction times (RTs) to visual stimuli due to mental fatigue remain largely unknown. We compare the differences in RT and heart rate after an acute intervention of mental fatigue between male and female athletes

Avaliação da coluna lombar e torácica nas situações com salto alto e com os pés descalços com o instrumento arcômetro

For many years, high heels have been a great ally of women becoming an important tool in their everyday lives. However, its use, especially indiscriminate in the point of view of the use frequency or heel height, can bring harm to the body, which, in the search for better balance, may favor body posture changes by bringing injuries to the feet and to the spine. The aims of this study were: to identify the curvatures position of the vertebral, thoracic, and lumbar spines of university students from the knowledge of curvature angles and to compare this approach in situations with high heels and barefoot. Thirty-four female students were evaluated, and their mean age was 20±1.9 years-old, using the arcometer instrument, in situations with high heels, 9 inches tall and barefoot. The arcometer was placed on the spinous processes of T1, T12, L1 and L5 vertebrae, identified by palpation, and it provided the angles of each of the bends. For verification of differences of the angles and body posture between both test situations, the t and χ² tests, were, respectively, used (a=0.05). The results showed that using high heels did not significantly alter the angles of curvature of the thoracic and lumbar spines and did not affect the classification of the body posture of physical therapy students, who mostly presented normal posture of the spine.O salto alto há muitos anos tem sido um grande aliado das mulheres, tornando-se uma ferramenta fundamental em seu dia a dia. Contudo, a utilização indiscriminada, seja do ponto de vista da frequência de utilização ou da altura do salto, pode trazer prejuízos para a saúde do corpo, que, a busca do melhor equilíbrio, pode desencadear alterações da postura, trazendo problemas para os pés e para a coluna vertebral. Os objetivos deste estudo foram: identificar a postura das curvaturas das colunas vertebral, torácica e lombar de estudantes universitárias, a partir do conhecimento dos ângulos destas curvaturas, e comparar esta postura nas situações com salto alto e com os pés descalços. Foram avaliadas 34 estudantes do sexo feminino, com idades médias de 20±1,9 anos, utilizando o instrumento arcômetro, nas situações com salto alto de 9 cm de altura e com pés descalços. O arcômetro foi colocado sobre os processos espinhosos das vértebras T1, T12, L1 e L5, identificados por palpação, e forneceu os ângulos das curvaturas. Para verificar as diferenças dos ângulos e da postura entre as duas situações de teste, foram utilizados o teste t pareado e o do χ², respectivamente (a=0,05). Os resultados demonstraram que a utilização de salto alto não modificou significativamente os ângulos das curvaturas torácica e lombar da coluna vertebral, bem como não interferiu na classificação da postura das estudantes universitárias, as quais, em sua maioria, apresentaram postura normal da coluna vertebral

Postural adjustments and biomechanics during gait initiation and obstacle negotiation: a cmparison between akinetic-rigid and hyperkinetic Parkinson’s disease

Individuals with Parkinson’s disease (PD) exhibit different combinations of motor symptoms. The most frequent subtypes are akinetic-rigid (AK-R) and hyperkinetic (HYP). Motor symptoms, such as rigidity and bradykinesia, can directly affect postural adjustments and performance in daily tasks, like gait initiation and obstacles negotiation, increasing the risk of falls and functional dependence. Objective: To compare postural adjustments and biomechanical parameters during the gait initiation and obstacle negotiation of people with AK-R and HYP PD and correlate with functional mobility and risk of falls. Methods: Cross-sectional study. Thirty-three volunteers with PD were divided into two groups according to clinical motor manifestations: AK-R (n = 16) and HYP (n = 17). We assessed the anticipatory (APA), compensatory (CPA) postural adjustments analyzing kinematic, kinetic and, electromyographic parameters during the gait initiation and obstacle negotiation tests. We applied independent T-tests and Pearson correlation tests for comparisons and correlations, respectively (α = 0.05). Results: In the APA phase of the gait initiation test, compared to the functional HYP group, the AK-R group showed shorter time for single support (p = 0.01), longer time for double support (p = 0.01) accompanied by a smaller first step (size, p = 0.05; height, p = 0.04), and reduced muscle activation of obliquus internus (p = 0.02). Similarly, during the first step in the obstacle negotiation test, the AK-R group showed less step height (p = 0.01) and hip excursion (p = 0.02), accompanied by a reduced mediolateral displacement of the center of pressure (p = 0.02) during APA, and activation of the gluteus medius (p = 0.02) and the anterior tibialis (p = 0.04) during CPA in comparison with HYP group. The findings suggest that people with AK-R present impaired postural adjustments during gait initiation and obstacles negotiation compared to hyperkinetic PD. Based on defined motor symptoms, the proposition presented here revealed consistent postural adjustments during complex tasks and, therefore, may offer new insights onto PD motor evaluation and neurorehabilitation

Effects of nordic walking on gait symmetry in mild Parkinson’s Disease

Individuals with Parkinson’s disease (PD) have gait asymmetries, and exercise therapy may reduce the differences between more and less affected limbs. The Nordic walking (NW) training may contribute to reducing the asymmetry in upper and lower limb movements in people with PD. We compared the effects of 11 weeks of NW aerobic training on asymmetrical variables of gait in subjects with mild PD. Fourteen subjects with idiopathic PD, age: 66.8 ± 9.6 years, and Hoehn and Yard stage of 1.5 points were enrolled. The kinematic analysis was performed pre and post-intervention. Data were collected at two randomized walking speeds (0.28 m·s−1 and 0.83 m·s−1) during five minutes on the treadmill without poles. The more affected and less affected body side symmetries (threshold at 5% between sides) of angular kinematics and spatiotemporal gait parameters were calculated. We used Generalized Estimating Equations with Bonferroni post hoc (α = 0.05). Maximal flexion of the knee (p = 0.007) and maximal abduction of the hip (p = 0.041) were asymmetrical pre and became symmetrical post NW intervention. The differences occurred in the knee was less affected and the hip was more affected. We concluded that 11 weeks of NW training promoted similarities in gait parameters and improved knee and hip angular parameters for PD subjects

Aquatic exercise associated or not with grape juice consumption-modulated oxidative parameters in Parkinson disease patients : a randomized intervention study

Parkinson's disease (PD) is a neurodegenerative disorder with significant motor disabilities and cognitive decline. Importantly, the imbalance of oxidative stress is related to PD physiopathology and progression. This study aimed to evaluate the impact of grape juice consumption associated with an aquatic exercise protocol on oxidative stress parameters and cognitive function in individuals with PD. The participants were randomized into two groups: grape juice group (GJG) and control group (CG) and were submitted to 4 weeks of an aquatic intervention (twice a week, approximately 60 minutes/session). The GJG also consumed 400 ml of grape juice per day (integral and conventional) during this period. Cognitive function was assessed by the Montreal Cognitive Assessment (MoCa) questionnaire. For the analysis of oxidative stress markers, specifically lipid oxidative damage (TBARS), proteins (Carbonil), acid uric and the activity of antioxidant enzymes (superoxide dismutase, glutathione peroxidase and catalase), blood collection were done before and after intervention. No changes were observed in cognitive function after intervention in both groups. Regarding biomarkers, a reduction of antioxidant enzymes, thiobarbituric acid reactive substances (TBARS) and uric acid was observed in both groups. However, only the GJG showed a significant reduction on protein oxidation levels after intervention. In conclusion, the consumption of grape juice associated with an aquatic exercise protocol might be consider an effective alternative to reduce the oxidative damage in PD, reinforcing the importance of this intervention in promoting beneficial impact in this population