Muscular weakness represents the main limiting factor of walk, functional independence and quality of life of myelopathy patients associated to HTLV-1

Renata Costa Caiafa; Marco Orsini; Lilian R. Felicio; Marzia Puccioni-Sohler

doi:10.1590/0004-282X20160019

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(04): 280-286
DOI: 10.1590/0004-282X20160019

ARTICLE

Muscular weakness represents the main limiting factor of walk, functional independence and quality of life of myelopathy patients associated to HTLV-1

Fraqueza muscular representa o principal fator limitante da marcha, independência funcional e qualidade de vida de pacientes com mielopatia associada ao HTLV-1

Renata Costa Caiafa

¹Universidade Federal do Rio de Janeiro, Pós-Graduação em Doenças Infecciosas e Parasitárias,Rio de JaneiroRJ,Brazil;

,

Marco Orsini

²Centro Universitário Augusto Motta, Pós-Graduação em Ciências de Reabilitação,Rio de JaneiroRJ,Brazil;

,

Lilian R. Felicio

³Universidade Federal de Uberlândia,Faculdade de Fisioterapia,UberlandiaMG,Brazil;

,

Marzia Puccioni-Sohler

¹Universidade Federal do Rio de Janeiro, Pós-Graduação em Doenças Infecciosas e Parasitárias,Rio de JaneiroRJ,Brazil;

⁴Universidade Federal do Rio de Janeiro,Hospital Universitário Gaffree & Guinle, Pós-Graduação em HIV/AIDS e Hepatite Viral,Rio de JaneiroRJ,Brazil.

› Author Affiliations

Abstract

ABSTRACT

HTLV-1-associated myelopathy is a progressive disabling disease associated with gait abnormalities.

Objective To identify and quantify the main muscles affected by weakness and spasticity, their impact on gait, functional capacity and on quality of life of HTLV-1-associated myelopathy patients.

Method We evaluated lower limbs muscular strength according to the Medical Research Council scale, spasticity according to the modified Ashworth scale, daily activities according to the Barthel Index and quality of life according to the Short-Form Health Survey-36 of 26 HTLV-1-associated myelopathy patients.

Results The muscles most affected by weakness included the dorsal flexors and knee flexors. Spasticity predominated in the hip adductor muscles and in plantar flexors. Assistance for locomotion, minimal dependence in daily activities, limitations in functional capacity and physical aspects were the most common findings.

Conclusion The impairment of gait, functional dependence and quality of life were predominantly a consequence of intense muscle weakness in HTLV-1-associated myelopathy patients.

RESUMO

Mielopatia associada ao HTLV-1 é uma doença inflamatória, incapacitante e progressiva que acomete o sistema nervoso central.

Objetivo Identificar e quantificar os principais músculos comprometidos pela fraqueza e espasticidade, o impacto na capacidade funcional e na qualidade de vida dos pacientes com mielopatia associada ao HTLV-1.

Método Força muscular (Medical Research Council),espasticidade (escala Ashworth modificada), atividades de vida diária (Índice de Barthel) e qualidade de vida (Sh ort-Form Health Surv ey-36)foram avaliados em 26 pacientes.

Resultados Os principais músculos comprometidos pela fraqueza incluíram os flexores dorsais e flexores do joelho. A espasticidade predominou nos músculos adutores do quadril e nos flexores plantares. Assistência para locomoção, dependência mínima nas atividades diárias, limitações na capacidade funcional e os aspectos físicos representaram os achados mais frequentes.

Conclusão Dificuldade de deambulação, dependência funcional e prejuízo na qualidade de vida foram as principais consequências da intensa fraqueza muscular nos pacientes com mielopatia associada ao HTLV-1.

HAM/TSP - functional ability - gait - quality of life

HAM/TSP - avaliação funcional - marcha - qualidade de vida

Full Text

References

References
1 Osame M. Review of WHO Kagoshima meeting and diagnostic guidelines for HAM/TSP. In: Blattner W, editor. Human retrovirology: HTLV. New York: Raven; 1990. p. 191-7.
2 Castro-Costa CM, Araújo AQ, Menna-Barreto M, Penalva-de-Oliveira AC. [Guide of clinical management of HTLV patient: neurological aspects]. Arq Neuropsiquiatr. 2005;63(2B):548-51. Portuguese. doi:10.1590/S0004-282X2005000300036
3 Gessain A, Cassar Olivier. Epidemiological aspects and world distribution of HTLV-1 infection. Front Microbiol. 2012;3:388. doi:10.3389/fmicb.2012.00388
4 Casseb J. Is human T cell lymphotropic type 1 (HTLV-1) associated myelopathy/tropical spastic paraparesis (HAM/TSP) syndrome a neglected disease? PLoS Negl Trop Dis. 2009;3(11):e487. doi:10.1371/journal.pntd.0000487
5 Franzoi AC, Araújo AQ. Disability and determinants of gait performance in tropical spastic paraparesis/HTLV-I associated myelopathy (HAM/TSP). Spinal Cord. 2007;45(1):64-8. doi:10.1038/sj.sc.3101919
6 Gessain A, Gout O. Chronic myelopathy associated with human T-lymphotropic virus type I (HTLV-I). Ann Intern Med. 1992;117(11):933-46. doi:10.7326/0003-4819-117-11-933
7 Martins JV, Baptista AF, Araújo AQ. Quality of life in patients with HTLV-I associated myelopathy/tropical spastic paraparesis. Arq Neuropsiquiatr. 2012;70(4):257-61. doi:10.1590/S0004-282X2012005000006
8 Medical Research Council of the United Kingdom. Aids to examination of the peripheral nervous system. Palo Alto, Califórnia: Pedragon House; 1978. (Memorandum, n. 45).
9 Daniels L, Worthingham C. Muscle testing: techniques of manual examination. Philadelphia: WB Saunders; 1986.
10 Ashworth B. Preliminary trial of carisoprodal in multiple sclerosis. Practioner. 1964;192:540-2.
11 Bohannon RW, Smith MB. Interrater reability of a modificated Ashworth scale of muscle spasticity. Phys Ther. 1987;67:206-7.
12 Mahoney FI, Barthel DW. Functional evaluation: Barthel index. Md State Med J. 1965;14:61-5.
13 Ciconelli RM, Ferraz MB, Wilton S, Meinão I, Quaresma MR. Tradução para língua portuguesa e avaliação do questionário genérico de avaliação de qualidade de vida SF-36 (Brasil SF-36). Rev Bras Reumatol. 1999;39(3):143-50.
14 Carod-Arthal FJ, Mesquita HM, Ribeiro LS. Manifestaciones neurológicas y discapacidad em pacientes que padecen mielopatía associada al HTLV-I. Neurologia. 2007;22(2):78-84.
15 Sheean G, McGuire JR. Spastic hypertonia and movement disorders: pathophysiology, clinical presentation, and qualification. PM R. 2009;1(9):827-33. doi:10.1016/j.pmrj.2009.08.002
16 William WC. De Jong´s The neurologic examination. 7rd ed. Philadelphia: Lippincott Williams & Wilkins; 2013.
17 Jansen K, De Groote F, Aerts W, De Schutter J, Duysens J, Jonkers I. Altering length and velocity feedback during a neuro-musculoskeletal simulation of normal gait contributes to hemiparetic gait characteristics. J Neuroeng Rehabil. 2014;11(1):78. doi:10.1186/1743-0003-11-78
18 Ward AB. Spasticity treatment with botulinum toxins. J Neural Transm (Vienna). 2008;115(4):607-16. doi:10.1007/s00702-007-0833-2
19 Coutinho IJ, Galvão-Castro B, Lima J, Castello C, Eter D, Grassi MFR. Impact of HTLV-associated myelopathy/T tropical spastic paraparesis (HAM/TSP) on activities of daily living (ADL) in HTLV-1 infected patients. Acta Fisiatr. 2011;18(1):6-10. doi:10.5935/0104-7795.20110001
20 Shublaq M, Orsini M, Puccioni-Sohler M. Implications of HAM/TSP functional incapacity in the quality of life. Arq Neuropsiquiatr. 2011;69(2A):208-11. doi:10.1590/S0004-282X2011000200013