Respostas posturais reativas predizem quedas em pacientes com doença de Parkinson?
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Data
2019
Autores
Moraca, Gabriel Antonio Gazziero [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A principal consequência dos comprometimentos motores da doença de Parkinson (DP) é o aumento da ocorrência de quedas. Quedas podem causar complicações severas, como: fraturas, diminuição da independência e podem levar o indivíduo a óbito. Dessa forma, a predição da ocorrência das quedas tem se mostrado importante, principalmente em populações que são mais afetadas pelas mesmas. Pacientes com DP demonstram maior deslocamento do centro de massa (CoM) e do centro de pressão (CoP), e atraso na recuperação da estabilidade após perturbação externa, o que está relacionado com a ocorrência de quedas. O comportamento do CoP nos ajustes posturais de pacientes com DP vem sendo analisado em situações com perturbação da postura para evidenciar as alterações no controle postural desses indivíduos. Porém, em nosso conhecimento, não está claro se a análise do comportamento do CoP em situações com perturbação pode predizer quedas em pacientes com DP. Dessa forma, o objetivo do presente estudo foi analisar se o comportamento do CoP nas respostas posturais em situações com perturbações externas imprevisíveis é capaz de predizer quedas em pacientes com DP. Participaram do estudo 85 pacientes com DP. Foram realizadas avaliações clínicas (padrão ouro para a DP) e do controle postural após perturbação externa. Para avaliação do controle postural, os pacientes permaneceram em pé sobre uma plataforma de força que estava posicionada sobre o equipamento que provocou o deslocamento da base de suporte no sentido posterior (velocidade = 15cm/s e deslocamento = 5cm). A duração das tentativas foi de 20s e ocorreram perturbações externas em 5 das 15 tentativas de forma randômica. O comportamento do CoP foi analisado em dois janelamentos (momentos de perturbação e recuperação), sendo analisadas a amplitude de deslocamento e pico do posicionamento. Além disso, foram analisados o tempo para o pico e o tempo para recuperar a posição estável. A ocorrência de quedas foi registrada nos 12 meses subsequentes à avaliação do controle postural via contato telefônico e/ou entrevista pessoal. De acordo com o histórico de quedas, 29 pacientes reportaram ao menos uma queda no período de acompanhamento. Os pacientes foram distribuídos em dois grupos: não caidor (idade: 70,92 ± 9,11 anos; massa: 71,12 ± 11,54 kg; estatura: 161,69 ± 9,14 cm) e caidor (idade: 70,72 ± 7,45 anos; massa: 69,13 ± 9,49 kg; estatura: 161,23 ± 8,47 cm). Análise de curva ROC (receiver operating characteristic) foi utilizada para avaliar o desempenho das variáveis do CoP em predizer quedas no período de 12 meses. As variáveis identificadas com os melhores desempenhos em predizer quedas foram: amplitude de deslocamento (sensibilidade = 0,621; especificidade = 0,679) e pico do posicionamento do CoP (sensibilidade = 0,517; especificidade = 0,75), ambas no período de janelamento em relação à perturbação. A partir dos resultados, conclui-se que amplitude e pico do CoP na direção anteroposterior são preditores da ocorrência de quedas no período de 12 meses em pacientes com DP. Além disso, sugere-se que os déficits no controle postural que podem ocasionar quedas em pacientes com DP estão relacionados com a capacidade de conter uma perturbação.
The main consequence of the motor impairment of Parkinson's disease (PD) is the increased occurrence of falls. Falls can cause severe complications such as fractures, decreased independence and can lead to death. Thus, the prediction of the occurrence of falls has been important, especially in populations that are most affected by falls. Patients with PD showed greater displacement of the center of mass (CoM) and of the center of pressure (CoP), and delayed recovery of the stability after external perturbation, which is related to the occurrence of falls. The CoP behavior in the postural adjustments of patients with PD has been analyzed in situations with postural perturbation to evidence changes in postural control of these individuals. However, to our knowledge, it is not clear if the analysis of CoP behavior in perturbation situations can predict falls in patients with PD. Thus, the aim of the present study was to analyze if the behavior of CoP in postural responses in situations with unpredictable external perturbation is able to predict falls in patients with PD. Eighty-five patients with PD participated in the study, however, one patient was excluded from the analysis due to dementia. Clinical evaluations (gold standard for PD) and postural control after external perturbation were performed. For evaluation of postural control, patients remained standing on a force platform that was positioned on the equipment that induced the perturbation of the support base in the posterior direction (velocity = 15 cm/s and displacement = 5 cm). The duration of the trials was 20s and external perturbations occurred in 5 out of 15 trials randomly. The behavior of CoP was analyzed in two windows (regarding the moments of perturbation and recuperation), being analyzed the range of displacement and peak of positioning. In addition, the time to peak and the time to recover the stable position were analyzed. Falls were recorded within 12 months of postural control assessment via telephone contact and/or personal interview. According to the history of falls, 29 patients reported at least one fall in the follow-up period. The patients were splited into two groups: non-fallers (age: 70.92±9.11 years; body mass: 71.12±11.54 Kg; height: 161.69±9.14 cm) and fallers group (age: 70.72±7.45 years; body mass: 69.13±9.49 Kg; height: 163.23±8.47 cm). Receiver operating characteristic (ROC) analysis was used to evaluate the performance of CoP variables in predicting falls over a 12-month period. The variables identified with the best performance in predicting falls were: range of displacement (sensitivity = 0.621; specificity = 0.679) and the peak of CoP positioning (sensitivity = 0.517; specificity = 0.75), both in the windowed period in relation to the perturbation. From the results, it can be concluded that the range and peak of CoP in the anteroposterior direction are possible predictors of 12-month falls in patients with PD. In addition, it appears that the deficits in the postural control of the patients with PD that could lead to falls are related to the ability to contain a perturbation.
The main consequence of the motor impairment of Parkinson's disease (PD) is the increased occurrence of falls. Falls can cause severe complications such as fractures, decreased independence and can lead to death. Thus, the prediction of the occurrence of falls has been important, especially in populations that are most affected by falls. Patients with PD showed greater displacement of the center of mass (CoM) and of the center of pressure (CoP), and delayed recovery of the stability after external perturbation, which is related to the occurrence of falls. The CoP behavior in the postural adjustments of patients with PD has been analyzed in situations with postural perturbation to evidence changes in postural control of these individuals. However, to our knowledge, it is not clear if the analysis of CoP behavior in perturbation situations can predict falls in patients with PD. Thus, the aim of the present study was to analyze if the behavior of CoP in postural responses in situations with unpredictable external perturbation is able to predict falls in patients with PD. Eighty-five patients with PD participated in the study, however, one patient was excluded from the analysis due to dementia. Clinical evaluations (gold standard for PD) and postural control after external perturbation were performed. For evaluation of postural control, patients remained standing on a force platform that was positioned on the equipment that induced the perturbation of the support base in the posterior direction (velocity = 15 cm/s and displacement = 5 cm). The duration of the trials was 20s and external perturbations occurred in 5 out of 15 trials randomly. The behavior of CoP was analyzed in two windows (regarding the moments of perturbation and recuperation), being analyzed the range of displacement and peak of positioning. In addition, the time to peak and the time to recover the stable position were analyzed. Falls were recorded within 12 months of postural control assessment via telephone contact and/or personal interview. According to the history of falls, 29 patients reported at least one fall in the follow-up period. The patients were splited into two groups: non-fallers (age: 70.92±9.11 years; body mass: 71.12±11.54 Kg; height: 161.69±9.14 cm) and fallers group (age: 70.72±7.45 years; body mass: 69.13±9.49 Kg; height: 163.23±8.47 cm). Receiver operating characteristic (ROC) analysis was used to evaluate the performance of CoP variables in predicting falls over a 12-month period. The variables identified with the best performance in predicting falls were: range of displacement (sensitivity = 0.621; specificity = 0.679) and the peak of CoP positioning (sensitivity = 0.517; specificity = 0.75), both in the windowed period in relation to the perturbation. From the results, it can be concluded that the range and peak of CoP in the anteroposterior direction are possible predictors of 12-month falls in patients with PD. In addition, it appears that the deficits in the postural control of the patients with PD that could lead to falls are related to the ability to contain a perturbation.
Descrição
Palavras-chave
Educação física, Controle motor, Doença de Parkinson, Predição de quedas, Perturbação externa, Centro de pressão, Controle postural, Doenças neurodegenerativas, Prediction of falls, External perturbation, Center of pressure, Postural control, Neurodegenerative diseases