Ajustes posturais sob perturbação externa em indivíduos com doença de Parkinson e neurologicamente sadios
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2017-08-29
Autores
Beretta, Victor Spiandor [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: A manutenção da postura emprega mecanismos de controle preditivos e reativos. Indivíduos com doença de Parkinson (DP) apresentam declínio no controle postural, principalmente na presença de perturbações externas. O uso de informações adicionais sobre a perturbação postural parece ser eficiente para melhorar o controle postural de idosos neurologicamente sadios, porém, na DP ainda é pouco conhecido. Objetivos: a) comparar as respostas dos ajustes posturais preditivos e reativos em idosos neurologicamente sadios (GC) e com DP (Estudo 1); b) verificar o efeito do fornecimento de informações adicionais nos ajustes posturais preditivos e reativos (Estudo 2). Metodologia: Participaram do Estudo 1, 39 (19 com DP e 20 GC) e do Estudo 2, 36 (17 com DP e 19 GC) selecionados na comunidade. Os indivíduos ficaram em pé sobre um equipamento que provocou a perturbação pelo deslocamento da base de suporte com intensidade de 15 cm/s e deslocamento de 5 cm. A perturbação inesperada foi apenas a primeira tentativa e, posteriormente, foram realizadas mais 15 tentativas em que apenas 5 ocorreram a perturbação de maneira imprevisível para análise da habituação à tarefa (Estudo 1). Para o Estudo 2 foram realizadas 20 tentativas com o fornecimento de informações adicionais sobre a perturbação, visual, verbal e somatossensorial do músculo requerido. Os dados EMG e CoP na condição inesperada foram analisados por meio de ANOVA one-way e nas perturbações imprevisíveis (Estudo 1 e 2) por meio de ANOVAs two-way. Resultados: Na perturbação inesperada, os idosos com DP apresentaram maiores valores nos parâmetros da EMG e do CoP em relação ao GC. Na habituação à perturbação, os idosos com DP adaptaram os padrões nos ajustes posturais reativos de forma tardia quando comparados ao GC. Em relação ao efeito das informações adicionais no controle postural, os idosos com DP apresentaram menor oscilação do CoP nos ajustes posturais preditivos em todas as condições de informações quando comparados ao GC. Já o GC aumentou a oscilação do CoP nos ajustes preditivos, considerando as mesmas condições. Nos ajustes posturais reativos, ambos os grupos apresentaram efeitos positivos das informações verbais e somatossensoriais, diminuindo os parâmetros temporais, de amplitude da EMG e espaciais do CoP em relação ás tentativas sem o seu fornecimento ou com o as demais informações (sobre a perturbação e visual). Além disso, os idosos com DP apresentaram controle postural mais adequado quando fornecida informação somatossensorial em relação às demais informações. Por fim, apesar das alterações positivas nos ajustes reativos, os idosos com DP apresentaram maior coativação muscular e tempo para recuperar a posição estável em relação ao GC. Conclusão: Idosos com DP possuem pior controle postural em situações com perturbações externas inesperada e imprevisível, evidenciando alterações temporais, na amplitude da EMG e espaciais do CoP. Além disso, idosos neurologicamente sadios e com DP conseguem alterar os padrões dos ajustes posturais com a exposição de perturbações externas, porém, na DP essa habituação é mais atrasada. As informações adicionais somatossensoriais parecem ter efeito positivo no controle postural dos idosos, principalmente na DP, diminuindo os parâmetros EMG e do CoP nos ajustes preditivos e reativos.
Introduction: Predictive and reactive postural mechanisms are necessary to maintain the posture. Patients with Parkinson's disease (PD) have a decline in postural control, mainly when occur an external perturbation. The use of additional information about the postural perturbation seems to be efficient to improve the postural control of neurotypical older people, but in PD it is still unclear. Aims: a) To compare the predictive and reactive postural adjustments responses in the neurotypical older people (CG) and the PD patients (Study 1); b) To verify the effect of additional information on predictive and reactive postural adjustments (Study 2). Methods: Participated thirty-nine (19 with PD and 20 GC) in the Study 1 and 36 (17 with PD and 19 GC) in the Study 2, selected in the community. The individuals stood on equipment that caused the perturbation by the displacement of the support base with the velocity of 15 cm/s and the range of 5 cm. The unexpected perturbation was the first trial, and 15 trials were realized in which in just 5 occurred the unpredictably perturbation to analyze the habituation to the task (Study 1). In the Study 2, 20 trail were realized with the additional information about the perturbation characteristics, visual, verbal, and somatosensory of the required muscle. The EMG and CoP data in the unexpected condition were analyzed by ANOVA one-way and in the unpredictable perturbations (Study 1 and 2) by the ANOVAs two-way. Results: In the unexpected perturbation, the PD patients presented higher temporal, range of EMG and spatial of CoP in relation to the CG. For the habituation to the perturbation, the patients with PD adapted the patterns in the reactive postural adjustments of delayed form when compared to the GC. In relation to the effect of the additional information on postural control, the PD patients presented lower CoP oscillation in the predictive postural adjustments in all the information conditions when compared to the CG. The GC increased the CoP oscillation in the predictive adjustments, considering the same information conditions. Both groups presented positive effects of verbal and somatosensory information in the reactive postural adjustments, decreasing temporal, range of EMG and spatial parameters of CoP in relation to trial without the information or with other information (about perturbation and visual). In addition, the PD patients presented more adequate postural control when somatosensory information was provided in relation to the other information. Finally, despite of the improvement in the reactive adjustments, patients with PD have a greater muscular coactivation and time to recover the stable position in relation to the CG. Conclusion: Patients with PD have worse postural control in situations with unexpected and unpredictable external perturbation, evidencing changes in the temporal, range of EMG and spatial of CoP parameters. In addition, neurotypical older people and PD patients can change the patterns of postural adjustments with the exposure of external perturbation, but in PD this habituation is more delayed. Besides that, somatosensory information seems to have a positive effect on the postural control of the older people, mainly in the PD, decreasing the EMG and CoP parameters in the predictive and reactive postural adjustments.
Introduction: Predictive and reactive postural mechanisms are necessary to maintain the posture. Patients with Parkinson's disease (PD) have a decline in postural control, mainly when occur an external perturbation. The use of additional information about the postural perturbation seems to be efficient to improve the postural control of neurotypical older people, but in PD it is still unclear. Aims: a) To compare the predictive and reactive postural adjustments responses in the neurotypical older people (CG) and the PD patients (Study 1); b) To verify the effect of additional information on predictive and reactive postural adjustments (Study 2). Methods: Participated thirty-nine (19 with PD and 20 GC) in the Study 1 and 36 (17 with PD and 19 GC) in the Study 2, selected in the community. The individuals stood on equipment that caused the perturbation by the displacement of the support base with the velocity of 15 cm/s and the range of 5 cm. The unexpected perturbation was the first trial, and 15 trials were realized in which in just 5 occurred the unpredictably perturbation to analyze the habituation to the task (Study 1). In the Study 2, 20 trail were realized with the additional information about the perturbation characteristics, visual, verbal, and somatosensory of the required muscle. The EMG and CoP data in the unexpected condition were analyzed by ANOVA one-way and in the unpredictable perturbations (Study 1 and 2) by the ANOVAs two-way. Results: In the unexpected perturbation, the PD patients presented higher temporal, range of EMG and spatial of CoP in relation to the CG. For the habituation to the perturbation, the patients with PD adapted the patterns in the reactive postural adjustments of delayed form when compared to the GC. In relation to the effect of the additional information on postural control, the PD patients presented lower CoP oscillation in the predictive postural adjustments in all the information conditions when compared to the CG. The GC increased the CoP oscillation in the predictive adjustments, considering the same information conditions. Both groups presented positive effects of verbal and somatosensory information in the reactive postural adjustments, decreasing temporal, range of EMG and spatial parameters of CoP in relation to trial without the information or with other information (about perturbation and visual). In addition, the PD patients presented more adequate postural control when somatosensory information was provided in relation to the other information. Finally, despite of the improvement in the reactive adjustments, patients with PD have a greater muscular coactivation and time to recover the stable position in relation to the CG. Conclusion: Patients with PD have worse postural control in situations with unexpected and unpredictable external perturbation, evidencing changes in the temporal, range of EMG and spatial of CoP parameters. In addition, neurotypical older people and PD patients can change the patterns of postural adjustments with the exposure of external perturbation, but in PD this habituation is more delayed. Besides that, somatosensory information seems to have a positive effect on the postural control of the older people, mainly in the PD, decreasing the EMG and CoP parameters in the predictive and reactive postural adjustments.
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Palavras-chave
Doença de Parkinson, Controle postural, Perturbação externa, Habituação, Informações adicionais, Parkinson's disease, Postural control, External perturbation, Habituation, Additional information