Complexidade do ambiente e assimetria no andar de idosos com doença de Parkinson
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Data
2015-12-18
Autores
Orcioli-Silva, Diego [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A presente dissertação de mestrado é composta por dois estudos. O Estudo 1 analisou e comparou a influência do aumento da complexidade do ambiente nos parâmetros cinemáticos e cinéticos do andar de idosos com doença de Parkinson (DP) e idosos neurologicamente sadios. O Estudo 2 analisou e comparou a assimetria do andar de idosos com DP e idosos neurologicamente sadios em ambientes com múltiplos obstáculos. Materiais e método: A amostra do estudo foi composta por 38 idosos, sendo 19 idosos com DP e 19 idosos sadios. A tarefa experimental consistiu em andar em velocidade preferida nas seguintes condições: sem ultrapassagem de obstáculo; com ultrapassagem de um obstáculo; com ultrapassagem de dois obstáculos a 108cm de distância entre eles (Estudo 1), ainda, no Estudo 2 foi acrescentada a condição com ultrapassagem de dois obstáculos a 50cm de distância entre eles. No Estudo 1, a ultrapassagem foi realizada com o membro inferior direito e, no Estudo 2, com ambos os membros inferiores. Para o andar sem obstáculo, foi analisada a passada central. Nas condições com obstáculo(s) foram analisadas as fases de aproximação e ultrapassagem, sendo que, na condição com dois obstáculos, a análise foi realizada apenas para o primeiro obstáculo. No Estudo 1 foram analisados os parâmetros cinemáticos e cinéticos do andar e no Estudo 2 foi calculado o Índice de Assimetria para cada variável do andar. Resultados: Estudo 1: os idosos diminuíram o comprimento da passada nas condições com 1 e 2 obstáculos e, na condição com 2 obstáculos, aumentaram a duração da passada. Ainda, os idosos com DP diminuíram a porcentagem em suporte simples e aumentou o duplo suporte em ambas as condições com obstáculos. Na fase de ultrapassagem, a presença de 2 obstáculos no andar exigiu ajustes cinemáticos e cinéticos (menor comprimento e velocidade do passo, menor distância horizontal e vertical entre o pé e o obstáculo e menor impulso horizontal de frenagem) mais acentuados comparado às outras condições. Estudo 2: os idosos com DP aumentaram a assimetria na fase de aproximação, especialmente nas variáveis temporais do passo (duração e fase de balanço do passo), nas condições com múltiplos obstáculos. Na fase de ultrapassagem, os idosos com DP apresentaram maior assimetria na distância vertical do pé para o obstáculo. Conclusão: Os idosos realizam ajustes nos parâmetros do andar em ambientes com obstáculos. Devido à maior exigência motora, atencional e sensorial do ambiente com múltiplos obstáculos, os idosos aumentaram a duração da passada na fase de aproximação, demonstrando a necessidade de mais tempo para processar as informações do ambiente. Contudo, devido aos déficits na integração sensório-motora e comprometimentos motores dos idosos com DP, o andar em ambientes mais complexos é mais prejudicial para essa população, exacerbando a bradicinesia e a hipometria. Por fim, os idosos com DP apresentam maior assimetria no andar quando comparados a idosos sadios em ambiente com múltiplos obstáculos, principalmente na fase de aproximação.
Introduction: This dissertation consists of two studies. Study 1 investigated the influence of environmental complexity on kinematic and kinetic parameters of gait in people with Parkinson's disease (PD) and healthy older adults. Study 2 compared gait asymmetry between people with (PD) and healthy older adults while walking on an environment with multiple obstacles. Materials and method: Thirty-eight older adults (19 patients with PD and 19 healthy individuals) participated in the study. The experimental task required participants to walk at preferred speed under the following conditions: free (regular) walking, avoiding one obstacle, avoiding two obstacles placed 108cm apart (Study 1); in the Study 2, another experimental condition was added: avoiding two obstacles placed 50cm apart. In the Study 1, obstacle avoidance was performed with the right limb as the leading limb, while both limbs were used as the leading limb for the Study 2. For free walking condition, the stride cycle performed in the central area of the pathway was considered for analysis. For conditions with two obstacles, outcome measures included calculations related to the first obstacle only, considering both approach and crossing phases. In the Study 1, we calculated kinematic and kinetic parameters of walking; in the Study 2, we calculated the asymmetry index for each outcome measure. Results: Study 1: both people with PD and healthy individuals decreased the stride length while approaching obstacles (one or two) and increased stride duration while approaching two obstacles. Also, people with PD decreased the percentage of time spent in single support and increased the time spent in double support in both condition with one and two obstacles. For the crossing phase, the presence of 2 obstacles in the pathway required more evident kinematic and kinetic adjustments (decreases were observed for step length, step velocity, horizontal and vertical distances from the feet to the obstacle, and horizontal braking impulse) in comparison to the other experimental conditions. Study 2: people with PD increased asymmetry of walking in the approach phase, especially for temporal outcomes (step duration and swing phase) in the conditions with multiple obstacles. For the crossing phase, people with PD demonstrated higher asymmetry values than healthy older adults for toe clearance. Conclusion: both people with PD and healthy individuals were able to adapt walking behavior when faced with environmental constraints induced by obstacles. Due to increased attentional and sensorimotor requirements to succeed while walking in environments with multiple obstacles, both people with PD and healthy participants increased stride duration in the approach phase, suggesting that additional time is necessary to process information from the environment in this situation. However, due to deficits in sensorimotor integration and motor impairments of PD, walking in more complex environments is more harmful to patients with PD, exacerbating bradykinesia and hypometria. Lastly, people with PD demonstrated higher asymmetry of walking than healthy individuals in environment with multiple obstacles, especially in the approach phase.
Introduction: This dissertation consists of two studies. Study 1 investigated the influence of environmental complexity on kinematic and kinetic parameters of gait in people with Parkinson's disease (PD) and healthy older adults. Study 2 compared gait asymmetry between people with (PD) and healthy older adults while walking on an environment with multiple obstacles. Materials and method: Thirty-eight older adults (19 patients with PD and 19 healthy individuals) participated in the study. The experimental task required participants to walk at preferred speed under the following conditions: free (regular) walking, avoiding one obstacle, avoiding two obstacles placed 108cm apart (Study 1); in the Study 2, another experimental condition was added: avoiding two obstacles placed 50cm apart. In the Study 1, obstacle avoidance was performed with the right limb as the leading limb, while both limbs were used as the leading limb for the Study 2. For free walking condition, the stride cycle performed in the central area of the pathway was considered for analysis. For conditions with two obstacles, outcome measures included calculations related to the first obstacle only, considering both approach and crossing phases. In the Study 1, we calculated kinematic and kinetic parameters of walking; in the Study 2, we calculated the asymmetry index for each outcome measure. Results: Study 1: both people with PD and healthy individuals decreased the stride length while approaching obstacles (one or two) and increased stride duration while approaching two obstacles. Also, people with PD decreased the percentage of time spent in single support and increased the time spent in double support in both condition with one and two obstacles. For the crossing phase, the presence of 2 obstacles in the pathway required more evident kinematic and kinetic adjustments (decreases were observed for step length, step velocity, horizontal and vertical distances from the feet to the obstacle, and horizontal braking impulse) in comparison to the other experimental conditions. Study 2: people with PD increased asymmetry of walking in the approach phase, especially for temporal outcomes (step duration and swing phase) in the conditions with multiple obstacles. For the crossing phase, people with PD demonstrated higher asymmetry values than healthy older adults for toe clearance. Conclusion: both people with PD and healthy individuals were able to adapt walking behavior when faced with environmental constraints induced by obstacles. Due to increased attentional and sensorimotor requirements to succeed while walking in environments with multiple obstacles, both people with PD and healthy participants increased stride duration in the approach phase, suggesting that additional time is necessary to process information from the environment in this situation. However, due to deficits in sensorimotor integration and motor impairments of PD, walking in more complex environments is more harmful to patients with PD, exacerbating bradykinesia and hypometria. Lastly, people with PD demonstrated higher asymmetry of walking than healthy individuals in environment with multiple obstacles, especially in the approach phase.
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Palavras-chave
Andar, Doença de Parkinson, Ambiente com múltiplos obstáculos, Assimetria, Gait, Parkinson's disease, Environment with multiple obstacles, Asymmetry