Hemodinâmica no córtex pré-frontal durante o andar com manipulação do balanço dos braços de indivíduos com doença de Parkinson
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2019-12-20
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Universidade Estadual Paulista (Unesp)
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Além de apresentar déficits na movimentação dos membros inferiores, indivíduos com doença de Parkinson (PD) apresentam redução do balanço dos braços durante o andar, que estão relacionados com prejuízos na coordenação entre os membros durante o andar. Pacientes com DP e idosos neurotípicos são capazes de aumentar a amplitude e a frequência do balanço dos braços, a partir de instruções, e essa alteração no padrão de movimento dos braços ameniza os déficits no andar, causados pelo envelhecimento e pela DP. Estes resultados favorecem a especulação do envolvimento do córtex pré-frontal quando o foco de atenção é dirigido para o comportamento dos membros superiores. Desta forma, os objetivos do presente estudo foram investigar a atividade cortical pré-frontal durante a realização do andar quando indivíduos com DP e idosos neurotípicos são instruídos a aumentar a amplitude e a frequência do balanço dos braços e verificar se essa manipulação do movimento dos membros superiores promove melhoras na coordenação entre os membros. Quinze idosos com DP e 13 idosos neurotípicos - grupo controle (GC) foram convidados. Para rastreio do quadro clínico (apenas para os pacientes), cognitivo e medicamentoso, a Unified Parkinson's Disease Rating Scale, o Mini-Exame do Estado Mental e uma anamnese foram empregados. Na sequência, os participantes foram instruídos a percorrer um circuito de 26,8 m de comprimento, em três condições experimentais, cinco tentativas para cada condição: andar em velocidade preferida (VP), andar com aumento da amplitude de movimento dos membros superiores (AB) e andar com aumento da frequência de movimento dos membros superiores (FB). Para o registro das variáveis relacionadas ao andar, foi utilizado um carpete com sensores de pressão. Para verificar a coordenação entre os membros, acelerômetros foram posicionados nos punhos, nos tornozelos e sobre a 5ª vertebra lombar, para registrar a aceleração dos segmentos corporais durante o andar. Os dados da atividade do córtex pré-frontal foram registrados por meio da técnica de espectroscopia funcional por infravermelho próximo, que registra a atividade hemodinâmica cerebral pelo software Oxysofttm®. Para a comparação entre os grupos (DP x GC) e as condições (VP x AB x FB), a ANOVA two-way com medidas repetidas para o fator condição foi utilizada, com o post hoc de Bonferroni caso houvesse interação entre os fatores. Os resultados mostraram que idosos com DP e neurotípicos apresentam padrões de coordenação e do andar diferentes e são capazes de modular, através da instrução com foco no movimento dos membros superiores, seus padrões de coordenação entre os membros, sem necessidade de envolver o córtex pré-frontal para manter o desempenho da tarefa. Considerando estes resultados, conclui-se que idosos com DP e idosos neurotípicos não necessitam recrutar recursos cognitivos para aumentar a amplitude ou a frequência de movimento dos braços e para manter o padrão de coordenação entre os membros superiores e inferiores durante o andar.
In addition to presenting deficits in lower limb movement, patients with Parkinson`s disease (PD) present reduction and asymmetry in arm swing during walking which are related to an impaired coordination between limbs during walking. Studies show that both PD patients and neurotypical elderly can follow instructions and increase the amplitude and frequency of the arm swing and this change in upper limb movement pattern are related to improvements in gait deficits caused by aging and PD symptoms. These results favor the speculation of prefrontal cortex involvement when the attentional focus is directed to upper limb behavior. The aims of the present study were to investigate prefrontal cortical activity during walking when PD patients and neurotypical elderly were instructed to increase the amplitude and frequency of arm swing and to verify if this manipulation of the upper limb movement improves the inter-limb coordination during walking. Fifteen PD patients and 13 neurotypical elderly - control group (GC) were recruited. For clinical and cognitive assessment, the Unified Parkinson's Disease Rating Scale, the Mini-Mental State Exam and an anamnesis were employed. Participants were instructed to walk over a 26.8 m pathway under three experimental conditions with five attempts for each condition: usual walking (UW), walking increasing the arm swing amplitude (IAA) and walking increasing the arm swing frequency (IAF). A carpet with pressure sensors was used to record walking variables. Accelerometers were placed on the wrists, ankles and on the 5th lumbar vertebra to record the acceleration of body segments during walking and to verify the coordination between limbs. Prefrontal cortex activity data were recorded using the near infrared functional spectroscopy technique that records cerebral hemodynamic activity using the Oxysofttm software. For the comparison between the groups (PD x CG) and conditions (UW x IAA x IAF), ANOVA two-way with repeated measures for the condition factor was used, with the Bonferroni post hoc if there was interaction between the factors. The results suggested that neurotypical elderly and PD have different coordination and walking patterns and are able to modulated, by means of the instruction of focusing on upper limb movement, their inter-limb coordination patterns without involving the prefrontal cortex to maintain task performance. Considering these results, is possible to conclude that neurotypical elderly and PD patients do not need to recruit cognitive resources to increase the amplitude or frequency of arm swing to maintain the inter-limb coordination pattern during walking.
In addition to presenting deficits in lower limb movement, patients with Parkinson`s disease (PD) present reduction and asymmetry in arm swing during walking which are related to an impaired coordination between limbs during walking. Studies show that both PD patients and neurotypical elderly can follow instructions and increase the amplitude and frequency of the arm swing and this change in upper limb movement pattern are related to improvements in gait deficits caused by aging and PD symptoms. These results favor the speculation of prefrontal cortex involvement when the attentional focus is directed to upper limb behavior. The aims of the present study were to investigate prefrontal cortical activity during walking when PD patients and neurotypical elderly were instructed to increase the amplitude and frequency of arm swing and to verify if this manipulation of the upper limb movement improves the inter-limb coordination during walking. Fifteen PD patients and 13 neurotypical elderly - control group (GC) were recruited. For clinical and cognitive assessment, the Unified Parkinson's Disease Rating Scale, the Mini-Mental State Exam and an anamnesis were employed. Participants were instructed to walk over a 26.8 m pathway under three experimental conditions with five attempts for each condition: usual walking (UW), walking increasing the arm swing amplitude (IAA) and walking increasing the arm swing frequency (IAF). A carpet with pressure sensors was used to record walking variables. Accelerometers were placed on the wrists, ankles and on the 5th lumbar vertebra to record the acceleration of body segments during walking and to verify the coordination between limbs. Prefrontal cortex activity data were recorded using the near infrared functional spectroscopy technique that records cerebral hemodynamic activity using the Oxysofttm software. For the comparison between the groups (PD x CG) and conditions (UW x IAA x IAF), ANOVA two-way with repeated measures for the condition factor was used, with the Bonferroni post hoc if there was interaction between the factors. The results suggested that neurotypical elderly and PD have different coordination and walking patterns and are able to modulated, by means of the instruction of focusing on upper limb movement, their inter-limb coordination patterns without involving the prefrontal cortex to maintain task performance. Considering these results, is possible to conclude that neurotypical elderly and PD patients do not need to recruit cognitive resources to increase the amplitude or frequency of arm swing to maintain the inter-limb coordination pattern during walking.
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Palavras-chave
Doença de Parkinson, Hemodinâmica do córtex pré-frontal, Coordenação entre os membros, Oxi-hemoglobina, Coordenação inter-membros, Andar, Parkinson's disease, Oxi-hemoglobin, Inter-limb coordination, Walk