Desvio de obstáculo e dupla tarefa motora durante a simulação de travessia de rua de indivíduos com Doença de Parkinson
Carregando...
Arquivos
Data
2018-03-20
Autores
Soares, Carolina Favarin [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O Brasil foi classificado como o quinto país com maior taxa de mortalidade decorrente de atropelamentos, na qual 52 % da população com mais de 60 anos de idade é acometida. A população afetada pela Doença de Parkinson (DP) possui déficits atencionais e na realização da dupla tarefa motora que aumentam o risco de atropelamentos, uma vez que além dos déficits motores, a capacidade de tomada de decisão e a resposta aos estímulos externos estão prejudicados. Objetivo: Analisar as características cinemáticas da marcha durante o desvio de obstáculo e realização de dupla tarefa motora de indivíduos com e sem a DP durante a simulação de travessia de rua. Métodos: Participaram do estudo 18 indivíduos sem alteração neurológica (grupo controle) e 18 indivíduos com DP idiopática que realizavam marcha independente. Os participantes atravessaram a passarela por cinco vezes em seis condições de marcha distintas que foram randomizadas por um dos avaliadores. As condições consistiam em marcha sem realizar tarefa concomitante (MN), marcha com desvio de obstáculo (MO), marcha com travessia de rua sem realizar tarefa concomitante (MNT), marcha com travessia carregando sacolas (MTS), marcha com travessia de rua desviando de obstáculo (MTO) e marcha com travessia de rua desviando de obstáculo e carregando sacolas (MTSO). A travessia de rua foi simulada por meio de um farol e um projetor e a coleta dos dados cinemáticos da marcha foi realizada pelo sistema de câmeras VICON® que coletou com frequência de amostragem de 100 Hz. Para análise estatística foi aplicado o teste de ANOVA para medidas repetidas com Post Hoc de Bonferroni adotando nível de significância de p < 0,05. Resultados: O grupo com DP apresentou comportamento da marcha mais prejudicado do que o grupo controle na variável duração de passo (s) (F= 2,572, p= 0,029). Já as comparações intragrupos tiveram diferença significativa entre as diferentes condições de marcha nas variáveis comprimento de passo (cm) (F=13,245, P<0,001), largura do passo (cm) (F=4,361, p=0,001), duração do passo (s) (F=2,879, p=0,016), velocidade do passo (cm/s) (F=3,995,p=0,002) e porcentagem de duplo suporte (%) (F=22,053, p=0,000) mostrando parâmetros cinemáticos da marcha com desvio de obstáculo pior do que marcha sem o desvio. Discussão: Indivíduos com DP apresentam dificuldade em se adaptar em condições que exigem maior foco atencional, como o desvio de obstáculo, isso ocorre por sua função executiva estar mais prejudicada do que no grupo controle. Além disso, a marcha carregando sacolas pode ter atuado de forma a melhorar a propriocepção do indivíduo durante a travessia. Conclusão: Indivíduos com DP apresentam valores de parâmetros cinemáticos da marcha menores do que o grupo controle e a marcha com desvio de obstáculo pode promover maiores déficits de parâmetros cinemáticos da marcha predispondo a um maior risco de atropelamentos.
Introduction: Brazil was ranked as the fifth country with the highest mortality rate due to road accidents such trampling, affecting 52% of the population over 60 years of age. The population affected by Parkinson's disease (PD) has deficits in attention and in the accomplishment of the double motor task that increases the risk of run over, since besides the motor deficits, the capacity of decision making and the response to the external stimulus are impaired. Objective: To analyze the kinematic characteristics of the gait during the obstacle deviation and the accomplishment of double motor task of individuals with and without PD during the simulation of street crossing. Methods: 18 individuals without neurological alterations and 18 individuals with idiopathic PD who performed independent gait participated in the study. Participants crossed the runway five times in six distinct gait conditions that were randomized by one of the raters. The conditions consisted of walking without concomitant task (MN), walking with obstacle bypass (MO), walking with street crossing without carrying out concomitant task (MNT), walking with crossing carrying bags (MTS), walking with crossing the street bypassing obstacle course (MTO) and road crossing with obstacle distraction and carrying bags (MTSO). The street crossing was simulated by means of a headlamp and a projector and the kinematic data of the gait was collected by the VICON® camera system, which was collected with a sampling frequency of 100 Hz. For statistical analysis, the ANOVA test was applied for repeated measures with Bonferroni’s Post Hoc adopting significance level of p <0.05. Results: The group with PD presented gait behavior more impaired than the control group in the step duration variable (F = 2,572, p = 0.029). Intragroup comparisons had a significant difference between the different gait conditions in the step length (cm) variables (F = 13.245, P <0.001), step width (cm) (F = 4,361, p = 0.001) (F = 2.879, p = 0.016), step velocity (cm / s) (F = 3.995, p = 0.002) and double support percentage (%) (F = 22.053, p = 0.000) showing kinematic parameters of the gait with obstacle deviation worse than gait without deviation. Discussion: Individuals with PD present difficulties in adapting to conditions that require greater attention focus, such as obstacle deviation, because their executive function is more impaired than in the CG. In addition, the gait carrying bags may have acted in a way to improve the individual's proprioception during the crossing. Conclusion: Individuals with PD present values of gait kinematic parameters lower than the GC, and gait with obstacle deviation can promote highest deficits in gait kinematic parameters, predisposing to a higher risk of running over.
Introduction: Brazil was ranked as the fifth country with the highest mortality rate due to road accidents such trampling, affecting 52% of the population over 60 years of age. The population affected by Parkinson's disease (PD) has deficits in attention and in the accomplishment of the double motor task that increases the risk of run over, since besides the motor deficits, the capacity of decision making and the response to the external stimulus are impaired. Objective: To analyze the kinematic characteristics of the gait during the obstacle deviation and the accomplishment of double motor task of individuals with and without PD during the simulation of street crossing. Methods: 18 individuals without neurological alterations and 18 individuals with idiopathic PD who performed independent gait participated in the study. Participants crossed the runway five times in six distinct gait conditions that were randomized by one of the raters. The conditions consisted of walking without concomitant task (MN), walking with obstacle bypass (MO), walking with street crossing without carrying out concomitant task (MNT), walking with crossing carrying bags (MTS), walking with crossing the street bypassing obstacle course (MTO) and road crossing with obstacle distraction and carrying bags (MTSO). The street crossing was simulated by means of a headlamp and a projector and the kinematic data of the gait was collected by the VICON® camera system, which was collected with a sampling frequency of 100 Hz. For statistical analysis, the ANOVA test was applied for repeated measures with Bonferroni’s Post Hoc adopting significance level of p <0.05. Results: The group with PD presented gait behavior more impaired than the control group in the step duration variable (F = 2,572, p = 0.029). Intragroup comparisons had a significant difference between the different gait conditions in the step length (cm) variables (F = 13.245, P <0.001), step width (cm) (F = 4,361, p = 0.001) (F = 2.879, p = 0.016), step velocity (cm / s) (F = 3.995, p = 0.002) and double support percentage (%) (F = 22.053, p = 0.000) showing kinematic parameters of the gait with obstacle deviation worse than gait without deviation. Discussion: Individuals with PD present difficulties in adapting to conditions that require greater attention focus, such as obstacle deviation, because their executive function is more impaired than in the CG. In addition, the gait carrying bags may have acted in a way to improve the individual's proprioception during the crossing. Conclusion: Individuals with PD present values of gait kinematic parameters lower than the GC, and gait with obstacle deviation can promote highest deficits in gait kinematic parameters, predisposing to a higher risk of running over.
Descrição
Palavras-chave
Doença de Parkinson, Transtornos parkinsonianos, Obstáculo, Marcha, Parkinson's disease, Parkinsonian disorders, Obstacle, Gait