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Davoudi M, Boostani R, Manzari ZS. Nonpharmacological interventions and outcomes in the management of complications of human T-cell lymphotropic virus type 1-related myelopathy/tropical spastic paraparesis: A systematic review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 28:87. [PMID: 38510783 PMCID: PMC10953734 DOI: 10.4103/jrms.jrms_300_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/02/2023] [Accepted: 10/09/2023] [Indexed: 03/22/2024]
Abstract
Background Human T-cell lymph tropic virus type 1 (HTLV-I)-related myelopathy/tropical spastic paraparesis (TSP) is a progressive inflammatory process affecting the spinal cord that occurs as a result of HTLV 1. The use of nonpharmacological approaches has always been one of the treatment strategies in these patients, but disagreement about these interventions and their results has led to their limited use. Therefore, this study aimed to identify nonpharmacological interventions and their consequences in these patients. Materials and Methods We followed the Cochrane Handbook for systematic reviews of interventions. The present report is organized according to the preferred reporting items for systematic reviews and meta-analyses. This study was conducted at PubMed, Cochrane Library, Web of Science, and Scopus, among all published studies by December 30, 2021. Keywords were: HTLV-1, Human T-lymph tropic virus 1, HTLV-I-associated myelopathy, HAM/TSP, tropical spastic paraparesis, nonpharmacological intervention, nonpharmacological treatment, massage, physiotherapy, acupuncture, acupressure, and exercise. The quality of the studies was assessed using JADAD. Results Of 288 articles, 11 were eligible for data extraction published between 2014 and 2021. 90/9% of studies were randomized clinical trials. 81/8% of articles were of high quality. The total sample size was 253 people, of which 137 (54/15%) were women. Approaches such as exercise and motion therapy, electrotherapy, behavioral therapy, and virtual reality can be used for these patients. With these interventions, results such as improved mobility and balance, physical condition, pain, quality of life, muscle spasticity, maximum inspiratory pressure, and urinary symptoms can be achieved. Conclusion The most common physical therapy method used in studies was active and passive body movements, which are associated with positive results for patients. Due to the small sample size in this group of studies, it is necessary to conduct more clinical trials for more accurate conclusions. Furthermore, due to the limited number of studies that have used electrical stimulation or combined intervention packages, it is not possible to say with certainty what effect these methods have on patients. It is necessary to conduct more clinical trials.
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Affiliation(s)
- Malihe Davoudi
- Department of Community Health Nursing, Nursing and Midwifery School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Boostani
- Department of Neurology, Faculty of Medicine, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Sadat Manzari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Schmidt FR, Coutinho ES, Lima MA, Silva MT, Leite AC, Fonseca IO, Araujo AQ. Performance of the National Institute of Infectious Diseases disability scale in HTLV-1-associated myelopathy/tropical spastic paraparesis. J Neurovirol 2023; 29:555-563. [PMID: 37400732 DOI: 10.1007/s13365-023-01154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a chronic disabling disease. However, there is a lack of an adequate and specific health measurement instrument validated and with good performance to assess their degree of physical disability. This led us to carry out this study and to evaluate the performance of Fiocruz's National Institute of Infectious Diseases (IDS) disability scale, a specific instrument for HAM/TSP. Ninety-two HAM/TSP patients participated in the study. One researcher applied the IDS, IPEC scale, Disability Status Scale (DSS), Expanded DSS (EDSS), Osame scale, Beck Depression Inventory, and the WHOQOL-BREF questionnaire. In parallel, blindly, and separately, other researchers applied the IDS. An inter-rater reliability analysis of the IDS, correlation analysis with the other scales, and depression and quality of life questionnaires were performed. The applicability of the IDS was also evaluated. The IDS showed high reliability in all scores. The inter-rater reliability test for the total IDS score was 0.94 (0.82-0.98) on its four dimensions. The scale adequately indicated the different degrees of disability, presenting a distribution similar to normal. There was a high correlation with the other scales (Spearman coefficients > 0.80, p < 0.001). The scale had good acceptance among users and a short application time. IDS for HAM/TSP was reliable, consistent, easy, and fast to use. It can be used for both prospective evaluations and clinical trials. The present study supports the IDS as a valid instrument to measure disability in patients with HAM/TSP compared to previously used scales.
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Affiliation(s)
- Felipe R Schmidt
- Department of Neurology, Pedro Ernesto University Hospital, the University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Evandro Sf Coutinho
- Department of Epidemiology, Institute of Social Medicine Hésio Cordeiro, the University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marco A Lima
- Laboratory for Clinical Research in Neuroinfections (Lapclin-Neuro), National Institute of Infectious Diseases (INI), FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Marcus Tt Silva
- Laboratory for Clinical Research in Neuroinfections (Lapclin-Neuro), National Institute of Infectious Diseases (INI), FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Ana Ccb Leite
- Laboratory for Clinical Research in Neuroinfections (Lapclin-Neuro), National Institute of Infectious Diseases (INI), FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Igor O Fonseca
- Department of Neurology and Psychiatry, Paulista State University (UNESP), Botucatu, SP, Brazil
| | - Abelardo Qc Araujo
- Laboratory for Clinical Research in Neuroinfections (Lapclin-Neuro), National Institute of Infectious Diseases (INI), FIOCRUZ, Rio de Janeiro, RJ, Brazil.
- Postgraduate Program in Neurology and Neurosciences, Fluminense Federal University (UFF), Niteroi, RJ, Brazil.
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Matsuura E, Nozuma S, Dozono M, Kodama D, Tanaka M, Kubota R, Takashima H. Iliopsoas Muscle Weakness as a Key Diagnostic Marker in HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP). Pathogens 2023; 12:pathogens12040592. [PMID: 37111478 PMCID: PMC10143214 DOI: 10.3390/pathogens12040592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Human T-cell leukemia virus-1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a slowly progressive neurological disease that arises from HTLV-1 infection. Pathologically, the condition is characterized by diffuse myelitis, which is most evident in the thoracic spinal cord. Clinical manifestations of the infectious disease, HAM/TSP, are empirically known to include weakness of the proximal muscles of the lower extremities and atrophy of the paraspinal muscles, which is characteristic of the distribution of disturbed muscles usually seen in muscular diseases, except that the upper extremities are almost normal. This unique clinical presentation is useful information for physicians and physical therapists involved in diagnosing and rehabilitating patients with HAM/TSP, as well as critical information for understanding the pathogenesis of HAM/TSP. However, the precise pattern of muscle involvement in this condition has yet to be reported. The purpose of this study was to identify the muscles affected by HAM/TSP in order to understand the pathogenesis of HAM/TSP as well as to aid in the diagnosis and rehabilitation of HAM/TSP. A retrospective review of medical records was conducted on 101 consecutively admitted patients with HAM/TSP at Kagoshima University Hospital. Among 101 patients with HAM/TSP, all but three had muscle weakness in the lower extremities. Specifically, the hamstrings and iliopsoas muscle were the most frequently affected in over 90% of the patients. Manual muscle testing (MMT) revealed that the iliopsoas was the weakest of the muscles assessed, a consistent feature from the early to advanced stages of the disease. Our findings demonstrate a unique distribution of muscle weakness in HAM/TSP, with the proximal muscles of the lower extremities, particularly the iliopsoas muscle, being the most frequently and severely affected.
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Affiliation(s)
- Eiji Matsuura
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Satoshi Nozuma
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Mika Dozono
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
| | - Daisuke Kodama
- Division of Neuroimmunology, Joint Research Center for Human Retrovirus Infection, Kagoshima University, Kagoshima 890-8520, Japan
| | - Masakazu Tanaka
- Division of Neuroimmunology, Joint Research Center for Human Retrovirus Infection, Kagoshima University, Kagoshima 890-8520, Japan
| | - Ryuji Kubota
- Division of Neuroimmunology, Joint Research Center for Human Retrovirus Infection, Kagoshima University, Kagoshima 890-8520, Japan
| | - Hiroshi Takashima
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
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Landim C, Dias CMCC, Nascimento C, Goes ALB, Araújo THA, Ribeiro A, Oliveira FTD, Castro-Lima H, Boa-Sorte N, Galvão-Castro B. Impaired flexibility in patients with tropical spastic paraparesis/HTLV-associated myelopathy: evaluation via pendulum fleximeter. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:271-283. [PMID: 37059437 PMCID: PMC10104761 DOI: 10.1055/s-0043-1764417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Flexibility is crucial to the harmonious execution of joint movements. While skeletal muscle dysfunction in patients with HTLV-1 can interfere with mobility, it is unclear whether these patients experience reduced flexibility. OBJECTIVE To evaluate the differences in flexibility between HTLV-1-infected individuals with and without myelopathy compared with uninfected controls. We also investigated whether age, sex, body mass index (BMI), physical activity level, or lower back pain influence flexibility in HTLV-1-infected individuals. METHODS The sample consisted of 56 adults, of which 15 did not have HTLV-1, 15 had HTLV-1 without myelopathy, and 26 had TSP/HAM. Their flexibility was assessed using the sit-and-reach test and a pendulum fleximeter. RESULTS No differences in flexibility were observed between the groups with and without myelopathy and controls without HTLV-1 infection using the sit-and-reach test. The pendulum fleximeter results of individuals with TSP/HAM presented the lowest flexibility among the groups with respect to trunk flexion, hip flexion and extension, knee flexion, and ankle dorsiflexion, even after adjusting for age, sex, BMI, level of physical activity, and lower back pain using multiple linear regression models. Additionally, HTLV-1-infected individuals without myelopathy demonstrated reduced flexibility in movements: knee flexion, dorsiflexion, and ankle plantar flexion. CONCLUSIONS Individuals with TSP/HAM demonstrated reduced flexibility in most of the movements evaluated by the pendulum fleximeter. Additionally, HTLV-1-infected individuals without myelopathy demonstrated reduced knee and ankle flexibility, potentially representing a marker of myelopathic development.
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Affiliation(s)
- Caroline Landim
- Escola Bahiana de Medicina e Saúde Pública, Salvador BA, Brazil
| | | | | | | | | | - Adriele Ribeiro
- Escola Bahiana de Medicina e Saúde Pública, Salvador BA, Brazil
| | | | | | - Ney Boa-Sorte
- Escola Bahiana de Medicina e Saúde Pública, Salvador BA, Brazil
- Universidade Federal da Bahia, Salvador BA, Brazil
| | - Bernardo Galvão-Castro
- Escola Bahiana de Medicina e Saúde Pública, Salvador BA, Brazil
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Laboratório Avançado de Saúde Pública, Salvador BA, Brazil
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Benevides AL, Santana G, Sá KN. Spirituality as Strategies for Coping With Tropical Spastic Paraparesis: Results of Focus Group. JOURNAL OF RELIGION AND HEALTH 2022; 61:540-551. [PMID: 33417057 DOI: 10.1007/s10943-020-01162-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 06/12/2023]
Abstract
In the logic of integrality in health, one of the aspects less addressed by assistance services is the question of spirituality. This study utilized qualitative analysis from focus groups to identify whether spirituality can contribute to coping with problems arising from the HTLV-1 myelopathy associated or tropical spastic paraparesis (HAM/TSP). The testimonies were recorded and then transcribed. The information was then systematized by the analysis of thematic-categorical content. When giving voice to people who suffer from HAM/TSP, there is clear evidence that spirituality, understood broadly and not restricted to institutionalized religious practices, is expressed in narratives of feeling for others and trust in God. Through spiritual solutions, people with HAM/TSP find the strength to face their disability and pain.
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Affiliation(s)
| | - Genildes Santana
- Medical Service, Instituto Federal da Bahia, Salvador, Bahia, Brazil
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Macêdo MC, Mota RDS, Patrício NA, Baptista AF, Andrade Filho ADS, Sá KN. Response to: RSBMT-2018-0270.R2 - Pain and quality of life in human T cell lymphotropic virus type 1 associated myelopathy or tropical spastic paraparesis after home-based exercise protocol: Randomized clinical trial. Rev Soc Bras Med Trop 2022; 55:e0723. [PMID: 35674566 PMCID: PMC9176720 DOI: 10.1590/0037-8682-0723-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 12/30/2021] [Indexed: 11/22/2022] Open
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Dos Santos DN, Sá KN, Queirós FC, Paixão AB, Santos KOB, de Andrade RCP, Camatti JR, Baptista AF. Pain, psychoaffective symptoms, and quality of life in human T cell lymphotropic virus type 1 (HTLV-1): a cross-sectional study. J Neurovirol 2021; 27:838-848. [PMID: 33405200 DOI: 10.1007/s13365-020-00914-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/02/2020] [Accepted: 09/28/2020] [Indexed: 11/29/2022]
Abstract
The objective of this study is to describe the chronic pain characteristics in individuals infected with human T cell lymphotropic virus type 1 (HTLV-1) per subgroup (asymptomatic, oligosymptomatic, and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP)) compared with controls with chronic pain without HTLV-1. This is a cross-sectional study investigating associations between pain profile, psychopathological symptoms, and quality of life. Individuals infected with HTLV-1 refer high-intensity pain compared with controls, with more severe characteristics being present in oligosymptomatic and HAM/TSP individuals. Oligosymptomatic individuals have a tendency of diffuse and frequent pain, mainly in the head/neck region and more depressive symptoms, resembling nociplastic pain. Neuropathic pain was localized in the lower limbs in all infected groups, worse in HAM/TSP individuals, and associated with a worse perception of quality of life. Pain was associated to higher levels of TNF-alpha and interferon-gamma. HTLV-1 pain is generally more severe when compared with other chronic pain syndromes, being present mainly in the lower limbs. Certain characteristics are typical, depending on the affected group. Oligosymptomatic and HAM/TSP individuals present more diffuse pain, with higher intensity and greater impact in quality of life. Increased levels of inflammatory cytokines are associated with HTLV-1-related pain.
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Affiliation(s)
- Dislene Nascimento Dos Santos
- Graduate, Program on Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Nucleus of Studies on Health and Functionality, Federal University of Bahia, Salvador, Bahia, Brazil
- Immunology Service, Professor Edgard Santos Hospital, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Katia Nunes Sá
- Nucleus of Studies on Health and Functionality, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Fernanda C Queirós
- Nucleus of Studies on Health and Functionality, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Alaí Barbosa Paixão
- Nucleus of Studies on Health and Functionality, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | | | - Janine Ribeiro Camatti
- Graduate Program on Neuroscience and Cognition, Federal University of ABC, Sao Paulo, Santo Andre, Brazil
| | - Abrahão Fontes Baptista
- Graduate, Program on Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil.
- Nucleus of Studies on Health and Functionality, Federal University of Bahia, Salvador, Bahia, Brazil.
- Center for Mathematics, Computation and Cognition, Federal University of ABC, Santo Andre, Sao Paulo, Brazil.
- Graduate Program on Neuroscience and Cognition, Federal University of ABC, Sao Paulo, Santo Andre, Brazil.
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Klautau AV, da Silva Pinto D, Santana BB, Freitas Queiroz MA, Rangel da Silva ANM, Vieira Cayres-Vallinoto IM, Ishak R, Rosário Vallinoto AC. Pilates exercise improves the clinical and immunological profiles of patients with human T-cell lymphotropic virus 1 associated myelopathy: A pilot study. J Bodyw Mov Ther 2020; 24:1-8. [PMID: 32825975 DOI: 10.1016/j.jbmt.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/13/2019] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is an infectious chronic-inflammatory disease, which can lead to lower limb motions. METHODS The study evaluated the effects of serial Pilates exercises on the clinical and immunological profiles of patients with HAM/TSP. Eight patients with ages ranging from 39 to 70 years old (2 males and 6 females), 2 wheelchair users and 6 with compromised gait, were evaluated. The patients were submitted to 20 Pilates sessions for 10 weeks. Data were collected at 3 time points (beginning of the study, after Pilates sessions and after 10 weeks without Pilates) and consisted of evaluations of the pain level, spasticity, motor strength, balance, mobility, functional capacity, quality of life and quantification of IFN-γ, IL-10 and IL-9 cytokines levels. RESULTS After the Pilates sessions, significant improvements in pain level, static and dynamic balance, trunk control, mobility and quality of life were observed, with simultaneous and significant reductions in the serum levels of the cytokines IFN-γ and IL-10. However, after 10 weeks without Pilates, there were significant changes in terms of increasing pain and regression of mobility, with no changes in strength, spasticity, functional capacity in any of the periods of the study. CONCLUSIONS The results suggest that Pilates may be a promising auxiliary physical therapy for patients with HAM/TSP.
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Affiliation(s)
- Altair Vallinoto Klautau
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Guamá, 66.075-110, Pará state, Brazil
| | - Denise da Silva Pinto
- Institute of Health Sciences, Federal University of Pará, Umarizal, 66.050-060, Pará state, Brazil; Division of Tropical Medicine, Federal University of Pará, Umarizal, 66.050-060, Belém, Pará state, Brazil
| | - Bárbara Brasil Santana
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Guamá, 66.075-110, Pará state, Brazil
| | - Maria Alice Freitas Queiroz
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Guamá, 66.075-110, Pará state, Brazil
| | | | | | - Ricardo Ishak
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Guamá, 66.075-110, Pará state, Brazil
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Santana GO, Libório AM, Galvão AV, Pondé MP, Sá KN. Signs, meanings and practices of people living with human t-cell lymphotropic virus type 1 or tropical spastic myelopathy. J Patient Rep Outcomes 2020; 4:31. [PMID: 32367401 PMCID: PMC7198688 DOI: 10.1186/s41687-020-00198-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 04/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background Human T-cell lymphotropic virus type 1 (HTLV-1) spreads silently in the world’s population and causes several syndromes. Among these, HTLV-1 associated myelopathy, also called tropical spastic paraparesis (HAM/TSP), affects the nervous system. It causes sensorimotor losses, spasticity, muscle weakness, voiding and sexual dysfunction, pain, and balance disorders. There is limited knowledge of the feelings, experiences, and coping mechanisms associated with this neglected disease. The objective of the present qualitative study was to investigate the signs, meanings, and practices of people with HAM/TSP, through narratives obtained from focus groups and individual semi-structured face-to-face interviews. Results Thirty-eight individuals diagnosed with HAM/TSP participated in the study. The following categories and subcategories emerged from the participants: Signs—physical signs, symptoms, and discovery of the disease; Meanings—reaction to diagnosis and knowledge of disease, fears, and expectations; Practices—daily life, leisure, religious, and treatment activities. Conclusions People with HAM/TSP suffer from symptoms that limit their social participation, and they are affected by complex and multidimensional feelings. This awareness can contribute to the implementation of public policies—focused on the real perspective of these patients—that provide more directed, empathic, and harmonious care for these individuals.
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Affiliation(s)
| | - Ana Mary Libório
- Department of Post Graduate, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Ana Verena Galvão
- Multidisciplinary Reference Center for Assistance and Research for Family and Patients with HTLV the Assisting Teaching the Bahia School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Milena Pereira Pondé
- Department of Post Graduate, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Katia Nunes Sá
- Department of Post Graduate, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
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Mota RDS, Macêdo MC, Corradini S, Patrício NA, Baptista AF, Sá KN. The effect of home exercise on the posture and mobility of people with HAM/TSP: a randomized clinical trial. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:149-157. [PMID: 32236329 DOI: 10.1590/0004-282x20190169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 10/18/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Physical therapy has positive results in people with tropical spastic paraparesis (TSP). However, mobility and distance from rehabilitation centers limit the participation in outpatient programs. OBJECTIVE To evaluate the impact of a home exercise program on the posture and functional mobility of people with TSP. METHODS A randomized controlled trial comparing three groups of people who performed guided exercises from a guidebook for six months: supervised (SG), unsupervised (WG), and control (CG). Primary outcomes: postural angles (SAPO®) and functional mobility (TUG). SECONDARY OUTCOMES gait parameters (CVMob®). RESULTS The protocol described in the guidebook improved postural angles and functional mobility. There were also positive gait parameter effects (p<0.05). SG presented better responses than WG did, but both were preferable to CG. CONCLUSION Home exercises oriented by a guidebook may benefit posture, functional mobility and gait parameters in people with TSP, and physiotherapist supervision can ensure better results.
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Affiliation(s)
- Renata de Sousa Mota
- Centro de Ciência e Tecnologia em Energia e Sustentabilidade, Universidade Federal do Recôncavo da Bahia, Feira de Santana, BA, Brazil
| | - Maíra Carvalho Macêdo
- Fundação para Neurologia e Neurocirurgia, Instituto do Cérebro, Salvador, BA, Brazil
| | | | - Naiane Araújo Patrício
- Departamento de Tecnologias de Saúde, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
| | - Abrahão Fontes Baptista
- Centro de Matemática, Computação e Cognição, Universidade Federal do ABC, São Paulo, SP, Brazil
| | - Katia Nunes Sá
- Departamento de Fisioterapia, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
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Lago V, Conceição CSD, Pinto EBC, Costa JV, Sá KN. Center of gravity oscillations in HTLV-1-associated myelopathy/tropical spastic paraparesis. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Postural control in individuals with HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP) is usually compromised, which increases the risk of falls, makes it difficult to perform activities of daily living, and impairs the quality of life. The profile of the center of gravity oscillations in this population is unknown and may aid in clinical follow-up and research. Objective: To compare the stabilometric values between HAM/TSP and uninfected individuals and verify the existence of correlations between stabilometric variables and the Berg Balance Scale (BBS). Method: A cross-sectional observational study was performed with infected individuals, classified as defined and likely (WHO criteria), compared to accompanying persons and seronegative relatives. A baropodometry platform (Footwork®) was used to obtain the oscillation values of the body’s center of gravity in total oscillation area (TOA), anterior-posterior oscillation (APO) and lateral oscillation (LO). Mean values were correlated with BBS by Spearman’s Correlation (5% alpha). Approved by the ethical committee of Escola Bahiana de Medicina e Saúde Pública under Opinion 49634815.2.0000.5628. Results: An asymmetric distribution of all the stabilometric variables analyzed in the HAM/TSP population was found, different from the uninfected group (p < 0.05). It was also possible to verify strong to moderate and inverse correlations between the variables of center of gravity oscillation with the scores obtained in BBS, especially for TOA and LO. Conclusion: People with HAM/TSP presented higher values for the center of gravity oscillations and these were correlated with the BBS in the balance evaluation.
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Koyama RVL, Yoshikawa GT, Fujihara S, da Silva Dias GA, Virgolino RR, Rodrigues AR, Medeiros R, Simões Quaresma JA, Fuzii HT. Incomplete myelopathy and human T cell lymphotropic virus type-1 (HTLV-1). J Neurovirol 2018; 25:1-8. [PMID: 30291566 DOI: 10.1007/s13365-018-0677-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/01/2018] [Accepted: 09/07/2018] [Indexed: 11/28/2022]
Abstract
This was a cross-sectional prospective study. We performed a multivariate statistical analysis of the neurological signs and symptoms of patients infected with human T cell lymphotropic virus type 1 (HTLV-1) in an attempt to separate them into distinct groups and identify clinical-neurological manifestations that could differentiate the various profiles. The study was performed in the city of Belém (state of Pará), located in the Amazon region of Brazil, from 2014 to 2016. We determined muscle strength and tone, reflexes, sensations, sphincter function, gait, and the Expanded Disability Status Scale score among individuals with HTLV-I. We then used exploratory statistical methods in an attempt to find different profiles and establish distinct groups. We analyzed 60 patients with HTLV-1. The filtering of the data, performed with mixed PCA, gave rise to a streamlined database with the most informative data and suggested the formation of three statistically distinct groups: asymptomatic carriers (AC), mono/oligosymptomatic (MOS), and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSPd), AC and MOS (p = 0.002), AC and HAM/TSPd (p < 0.001), and HAM/TSPd and MOS (p = 0.001). The subsequent cluster analysis confirmed the formation of three clusters. The classification and regression tree demonstrated that altered gait was the most important variable for the classification of an individual with HAM/TSPd and that, in the absence of this impairment, hyperreflexia characterized MOS. The present study was able to separate patients infected by HTLV-1 into three clinical groups (AC, HAM/TSPd, and MOS) and identify clinical manifestations that could differentiate the various patient groups.
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Affiliation(s)
- Roberta Vilela Lopes Koyama
- Center of Biological and Health Sciences, Pará State University, Tv Perebebuí, 2623, Marco, Belem, PA, 66095-662, Brazil.
| | - Gilberto Toshimitsu Yoshikawa
- Institute of Health Sciences, Federal University of Pará, Av Generalíssimo, 94, Umarizal, Belem, PA, 66050-160, Brazil
| | - Satomi Fujihara
- Tropical Medicine Group, Federal University of Pará, Av Generalíssimo, 92, Umarizal, Belem, PA, 66055-240, Brazil
| | - George Alberto da Silva Dias
- Center of Biological and Health Sciences, Pará State University, Tv Perebebuí, 2623, Marco, Belem, PA, 66095-662, Brazil
| | - Rodrigo Rodrigues Virgolino
- Tropical Medicine Group, Federal University of Pará, Av Generalíssimo, 92, Umarizal, Belem, PA, 66055-240, Brazil
| | - Anderson Raiol Rodrigues
- Tropical Medicine Group, Federal University of Pará, Av Generalíssimo, 92, Umarizal, Belem, PA, 66055-240, Brazil
| | - Rita Medeiros
- Tropical Medicine Group, Federal University of Pará, Av Generalíssimo, 92, Umarizal, Belem, PA, 66055-240, Brazil
| | | | - Hellen Thaís Fuzii
- Tropical Medicine Group, Federal University of Pará, Av Generalíssimo, 92, Umarizal, Belem, PA, 66055-240, Brazil
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Caporali JFDM, Labanca L, Florentino KR, Souza BO, Utsch Gonçalves D. Intrarater and interrater agreement and reliability of vestibular evoked myogenic potential triggered by galvanic vestibular stimulation (galvanic-VEMP) for HTLV-1 associated myelopathy testing. PLoS One 2018; 13:e0204449. [PMID: 30261002 PMCID: PMC6160040 DOI: 10.1371/journal.pone.0204449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/07/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The vestibular evoked myogenic potential triggered by galvanic vestibular stimulation (galvanic-VEMP) has been used to assess the function of the vestibulospinal motor tract and is a candidate biomarker to predict and monitor the human T-cell lymphotropic virus type 1 (HTLV-1) associated myelopathy (HAM). This study determined the agreement and reliability of this exam. METHODS Galvanic-VEMP was performed in 96 participants, of which 24 patients presented HAM, 27 HTLV-1-asymptomatic carriers, and 45 HTLV-1-negative asymptomatic controls. Galvanic vestibular stimulation was achieved by passing a binaural and bipolar current at a 2 milliamperes (mA) intensity for 400 milliseconds (ms) between the mastoid processes. Galvanic-VEMP electromyographic wave responses of short latency (SL) and medium latency (ML) were recorded from the gastrocnemius muscle. Intrarater (test-retest) and interrater (two independent examiners) agreement and reliability were assessed by standard error of measurement (SEM), coefficient of repeatability (CR), intraclass correlation coefficient (ICC), and Kappa coefficient. RESULTS In the total sample (n = 96), SL and ML medians were 56 ms (IQR 52-66) and 120 ms (IQR 107-130), respectively. The intrarater repeatability measures for SL and ML were, respectively: SEM of 6 and 8 ms; CR of 16 and 22 ms; ICC of 0.80 (p<0.001) and 0.91 (p<0.001); and a Kappa coefficient of 0.53 (p<0.001) and 0.82 (p<0.001). The interrater reproducibility measures for SL and ML were, respectively: SEM of 3 and 10 ms; CR of 8 and 27 ms; ICC of 0.95 (p<0.001) and 0.86 (p<0.001); and a Kappa coefficient of 0.77 (p<0.001) and 0.88 (p<0.001). CONCLUSION Galvanic-VEMP is a reliable and reproducible method to define the integrity of the vestibulospinal tract. Longitudinal studies will clarify its validity in the clinical context, aimed at achieving an early diagnosis and the monitoring of HAM.
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Affiliation(s)
- Júlia Fonseca de Morais Caporali
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- * E-mail: (JFMC); (DUG)
| | - Ludimila Labanca
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Kyonis Rodrigues Florentino
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bárbara Oliveira Souza
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Denise Utsch Gonçalves
- Programa de Pós-Graduação em Infectologia e Medicina Tropical, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- * E-mail: (JFMC); (DUG)
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Facchinetti LD, Araújo AQ, Silva MT, Leite ACC, Azevedo MF, Chequer GL, Oliveira RV, Ferreira AS, Lima MA. Home-based exercise program in TSP/HAM individuals: a feasibility and effectiveness study. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:221-227. [PMID: 28489141 DOI: 10.1590/0004-282x20170022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 12/22/2016] [Indexed: 12/14/2022]
Abstract
Objective To investigate the feasibility and effectiveness of a home-based exercise program in TSP/HAM individuals. Methods Twenty-three TSP/HAM individuals divided in two groups according to Timed Up and Go (TUG) score (<20s vs ≥20s) performed a 20-week home-based exercise program. The primary outcomes were exercise adherence, maximum voluntary isometric contraction of lower limbs (MVIC), Barthel Index and SF-36. Secondary outcomes were adverse effects and barriers to exercise practice. Results MVIC and the social functioning domain in SF-36 improved significantly in TUG <20s group. The individuals in the TUG ≥20s group improved significantly their physical functioning domain in SF-36. The total adherence to the 20-week home-based exercise program was 90%. There were mild to moderate adverse events related to exercise program. There were no adverse events related to MVIC test. Conclusions The home-based exercise program was feasible and effective in improving disability and quality of life in individuals with TSP/HAM.
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Affiliation(s)
- Lívia D Facchinetti
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Serviço de Fisioterapia, Rio de Janeiro RJ, Brasil
| | - Abelardo Q Araújo
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Neuroinfecção, Rio de Janeiro RJ, Brasil
| | - Marcus Tt Silva
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Neuroinfecção, Rio de Janeiro RJ, Brasil
| | - Ana Claudia C Leite
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Neuroinfecção, Rio de Janeiro RJ, Brasil
| | - Mariana F Azevedo
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Serviço de Fisioterapia, Rio de Janeiro RJ, Brasil
| | - Gisele L Chequer
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Serviço de Fisioterapia, Rio de Janeiro RJ, Brasil
| | - Raquel Vc Oliveira
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Epidemiologia Clínica, Rio de Janeiro RJ, Brasil
| | - Arthur S Ferreira
- Centro Universitário Augusto Motta, Programa de Pós-Graduação em Ciências da Reabilitação, Laboratório de Simulação Computacional e Modelagem em Reabilitação, Rio de Janeiro RJ, Brasil.,Universidade Salgado de Oliveira, Programa de Graduação em Fisioterapia, Rio de Janeiro RJ, Brasil
| | - Marco Antonio Lima
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Neuroinfecção, Rio de Janeiro RJ, Brasil
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Santos DND, Santos KOB, Paixão AB, Andrade RCPD, Costa DT, S-Martin DL, Sá KN, Baptista AF. Factors associated with pain in individuals infected by human T-cell lymphotropic virus type 1 (HTLV-1). Braz J Infect Dis 2016; 21:133-139. [PMID: 28011062 PMCID: PMC9427659 DOI: 10.1016/j.bjid.2016.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 12/14/2022] Open
Abstract
Introduction Despite the high prevalence of chronic pain in individuals infected with HTLV-1, predictive and protective factors for its development are still unclear. Objective To identify factors associated with chronic pain in individuals with HTLV-1. Methods This cross-sectional study was conducted in a reference center for treatment of patients infected with HTLV-1 in Salvador, Bahia, Brazil. The study included individuals infected with HTLV-1, over 18 years, and excluded those with difficulty to respond the pain protocol. Data on sociodemographic, health behavior, and clinical characteristics were collected in a standardized way. The prevalence ratio (PR) of pain is described, as well as the factors independently associated with the presence of pain, which were assessed by multiple logistic regression. Results A total of 142 individuals were included in the study, mostly female (62.7%), aged 20–64 years (73.2%), married (61.3%), with less than eight years of education (54.2%), and with a steady income (79.6%). Multivariate analysis showed that being symptomatic for HTLV-1 – sensory manifestations, erectile dysfunction, overactive bladder, and/or HAM/TSP (PR = 1.21, 95% CI: 1.05 to 1.38), self-medication (PR = 1.29, 95% CI: 1.08–1.53), physiotherapy (PR = 1.15, 95% CI: 1.02–1.28), and depression (PR = 1.14, 95% CI: 1.01–1.29) were associated with an increased likelihood of presenting pain. On the other hand, physical activity (PR = 0.79, 95% CI: 0.67–0.93) and religious practice (PR = 0.83, 95% CI: 0.72–0.95) were associated with a decreased likelihood of having pain. Conclusion The use of self-medication, physiotherapy and the presence of depression are independently associated with neurological symptoms in HTLV-1 infected patients. Religious practice and physical activity are both protective for the development of pain.
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Affiliation(s)
- Dislene N Dos Santos
- Universidade Federal da Bahia, Programa de Pós-graduação em Medicina e Saúde, Salvador, BA, Brazil; Universidade Federal da Bahia, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil; Universidade Federal da Bahia, Hospital Professor Edgard Santos, Serviço de Imunologia, Salvador, BA, Brazil
| | - Kionna O B Santos
- Universidade Federal da Bahia, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil
| | - Alaí B Paixão
- Universidade Federal da Bahia, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil
| | | | - Davi T Costa
- Universidade Federal da Bahia, Hospital Professor Edgard Santos, Serviço de Imunologia, Salvador, BA, Brazil; Universidade Estadual do Sudoeste da Bahia, Vitoria da Conquista, BA, Brazil
| | - Daniel L S-Martin
- Universidade Federal da Bahia, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil; Universidade Federal da Bahia, Faculdade de Medicina da Bahia, Salvador, BA, Brazil
| | - Katia N Sá
- Universidade Federal da Bahia, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil; Escola Bahiana de Medicina e Saúde Pública, Pós graduação e pesquisa, Salvador, BA, Brazil
| | - Abrahão F Baptista
- Universidade Federal da Bahia, Programa de Pós-graduação em Medicina e Saúde, Salvador, BA, Brazil; Universidade Federal da Bahia, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil; Escola Bahiana de Medicina e Saúde Pública, Pós graduação e pesquisa, Salvador, BA, Brazil.
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Giménez-Roldán S, Spencer P. Azañón's disease. A 19th century epidemic of neurolathyrism in Spain. Rev Neurol (Paris) 2016; 172:748-755. [DOI: 10.1016/j.neurol.2016.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 06/26/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
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Caiafa RC, Orsini M, Felicio LR, Puccioni-Sohler M. Muscular weakness represents the main limiting factor of walk, functional independence and quality of life of myelopathy patients associated to HTLV-1. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:280-6. [PMID: 27096999 DOI: 10.1590/0004-282x20160019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 11/30/2015] [Indexed: 11/22/2022]
Abstract
UNLABELLED 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.
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Affiliation(s)
| | - Marco Orsini
- Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brazil
| | - Lilian R Felicio
- Faculdade de Fisioterapia, Universidade Federal de Uberlândia, Uberlandia, MG, Brazil
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San-Martin DL, Santos DND, Baptista AF. Pain prevalence, characteristics and associated factors in human T-cell lymphotropic virus type 1 infected patients: a systematic review of the literature. Braz J Infect Dis 2016; 20:592-598. [PMID: 27768899 PMCID: PMC9427562 DOI: 10.1016/j.bjid.2016.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To describe the pain in patients infected with human T-cell lymphotropic virus type 1, clinically and epidemiologically. Methods This systematic review was based on The PRISMA Statement. Four reviewers searched PUBMED, SciELO, LILACS and BIREME for data from observational studies and clinical trials (n ≥ 30) regarding pain prevalence, characteristics, and associated factors in patients with human T-cell lymphotropic virus type 1. No limits on publication date or language were established. Studies that did not have pain as an outcome measure or not involving human T-cell lymphotropic virus type 1 infected patients were excluded. Results A total of 3013 articles (including duplicates) were found of which seven met the predetermined criteria. The most common pain region was the lower back (53.0%). Non-neuropathic type (ranging from 52.6% to 86.8%) was more frequent in human T-cell lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis participants, and neuropathic pain was more common in human T-cell lymphotropic virus type 1 carriers (53.1%). The pain was mostly reported as moderate or severe. One study showed that chronic pain was negatively associated with quality of life. Discussion Pain is a common complaint in human T-cell lymphotropic virus type 1 infected patients, with lower back pain as the most frequent site. Pain can either be nociceptive, neuropathic, or both, is frequently severe, and negatively affects quality of life. Only studies of two countries were included in this review, limiting the external validity of the conclusions. The heterogeneity of variables prevented us from implementing a meta-analysis. Further research should better characterize the pain and explore its impact on quality of life, especially using longitudinal study design.
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Affiliation(s)
| | - Dislene Nascimento Dos Santos
- Universidade Federal da Bahía, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil; Universidade Federal da Bahía, Programa de Pós-graduação em Medicina e Saúde, Salvador, BA, Brazil
| | - Abrahão Fontes Baptista
- Universidade Federal da Bahía, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil; Universidade Federal da Bahía, Departamento de Fisioterapia, Salvador, BA, Brazil.
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Adonis A, Taylor GP. Assessing Walking Ability in People with HTLV-1-Associated Myelopathy Using the 10 Meter Timed Walk and the 6 Minute Walk Test. PLoS One 2016; 11:e0157132. [PMID: 27336911 PMCID: PMC4919004 DOI: 10.1371/journal.pone.0157132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 05/25/2016] [Indexed: 12/14/2022] Open
Abstract
Background Five to ten million persons, are infected by HTLV-1 of which 3% will develop HTLV-1-associated myelopathy (HAM) a chronic, disabling inflammation of the spinal cord. Walking, a fundamental, complex, multi-functional task is demanding of multiple body systems. Restricted walking ability compromises activity and participation levels in people with HAM (pwHAM). Therapy aims to improve mobility but validated measures are required to assess change. Study Design Prospective observational study. Objectives To explore walking capacity in pwHAM, walking endurance using the 6 minute walk (6MW), and gait speed, using the timed 10m walk (10mTW). Setting Out-patient setting in an inner London Teaching hospital. Methods Prospective documentation of 10mTW and 6MW distance; walking aid usage and pain scores measured twice, a median of 18 months apart. Results Data analysis was completed for twenty-six pwHAM, (8♂; 18♀; median age: 57.8 years; median disease duration: 8 years). Median time at baseline to: complete 10m was 17.5 seconds, versus 21.4 seconds at follow up; 23% completed the 6MW compared to 42% at follow up and a median distance of 55m was covered compared to 71m at follow up. Using the 10mTW velocity to predict the 6MW distance, overestimated the distance walked in 6 minutes (p<0.01). Functional decline over time was captured using the functional ambulation categories. Conclusions The 10mTW velocity underestimated the degree of disability. Gait speed usefully predicts functional domains, shows direction of functional change and comparison with published healthy age matched controls show that these patients have significantly slower gait speeds. The measured differences over 18 months were sufficient to reliably detect change and therefore these assessments can be useful to detect improvement or deterioration within broader disability grades. Walking capacity in pwHAM should be measured using the 10mTW for gait speed and the 6MW for endurance.
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Affiliation(s)
- Adine Adonis
- National Centre for Human Retrovirology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, United Kingdom
- * E-mail:
| | - Graham P. Taylor
- National Centre for Human Retrovirology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, United Kingdom
- Section of Virology, Department of Medicine, Imperial College, London, W2 1PG, United Kingdom
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Buell KG, Puri A, Demontis MA, Short CL, Adonis A, Haddow J, Martin F, Dhasmana D, Taylor GP. Effect of Pulsed Methylprednisolone on Pain, in Patients with HTLV-1-Associated Myelopathy. PLoS One 2016; 11:e0152557. [PMID: 27077747 PMCID: PMC4831674 DOI: 10.1371/journal.pone.0152557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/16/2016] [Indexed: 12/14/2022] Open
Abstract
HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is an immune mediated myelopathy caused by the human T-lymphotropic virus type 1 (HTLV-1). The efficacy of treatments used for patients with HAM/TSP is uncertain. The aim of this study is to document the efficacy of pulsed methylprednisolone in patients with HAM/TSP. Data from an open cohort of 26 patients with HAM/TSP was retrospectively analysed. 1g IV methylprednisolone was infused on three consecutive days. The outcomes were pain, gait, urinary frequency and nocturia, a range of inflammatory markers and HTLV-1 proviral load. Treatment was well tolerated in all but one patient. Significant improvements in pain were: observed immediately, unrelated to duration of disease and maintained for three months. Improvement in gait was only seen on Day 3 of treatment. Baseline cytokine concentrations did not correlate to baseline pain or gait impairment but a decrease in tumour necrosis factor-alpha (TNF-α) concentration after pulsed methylprednisolone was associated with improvements in both. Until compared with placebo, treatment with pulsed methylprednisolone should be offered to patients with HAM/TSP for the treatment of pain present despite regular analgesia.
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Affiliation(s)
- Kevin G Buell
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom
| | - Aiysha Puri
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom
| | - Maria Antonietta Demontis
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom
| | - Charlotte L Short
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom
| | - Adine Adonis
- National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom
| | - Jana Haddow
- National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom
| | - Fabiola Martin
- Centre of Immunology and Infection, Hull York Medical School, Department of Biology, University of York, Heslington, York YO10 5DD, United Kingdom
| | - Divya Dhasmana
- National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom
| | - Graham P Taylor
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom
- National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom
- Centre of Immunology and Infection, Hull York Medical School, Department of Biology, University of York, Heslington, York YO10 5DD, United Kingdom
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Vasconcelos BHB, Souza GS, Barroso TGCP, Silveira LCL, Sousa RCM, Callegari B, Xavier MB. Barefoot Plantar Pressure Indicates Progressive Neurological Damage in Patients with Human T-Cell Lymphotropic Virus Type 1 Infection. PLoS One 2016; 11:e0151855. [PMID: 26998608 PMCID: PMC4801362 DOI: 10.1371/journal.pone.0151855] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/04/2016] [Indexed: 01/26/2023] Open
Abstract
Background The human T-Cell Lymphotropic Virus Type 1 (HTLV-1) is a retrovirus associated with neurological alterations; individuals with HTLV-1 infection may develop HTLV-1 associated myelopathy / tropical spastic paraparesis (HAM/TSP). Frequent neurological complaints include foot numbness and leg weakness. In this study, we compared the distribution of the body weight on different areas of the foot in HTLV-1 patients with HAM/TSP, asymptomatic HTLV-1 patients, and healthy individuals. Methodology We studied 36 HTLV-1 infected patients, who were divided in two groups of 18 patients each based on whether or not they had been diagnosed with HAM/TSP, and 17 control subjects. The evaluation included an interview on the patient’s clinical history and examinations of the patient’s reflexes, foot skin tactile sensitivity, and risk of falling. The pressure distribution on different areas of the foot was measured with baropodometry, using a pressure platform, while the patients had their eyes open or closed. Main Findings The prevalence of neurological disturbances—altered reflexes and skin tactile sensitivity and increased risk of falling—was higher in HTLV-1 HAM/TSP patients than in HTLV-1 asymptomatic patients. The medium and maximum pressure values were higher in the forefoot than in the midfoot and hindfoot in both HTLV-1 groups. In addition, the pressure on the hindfoot was lower in HAM/TSP patients compared to control subjects. Conclusions The neurological disturbances associated with HTLV-1 infection gradually worsened from HTLV-1 asymptomatic patients to HAM/TSP patients. Baropodometry is a valuable tool to establish the extent of neurological damage in patients suffering from HTLV-1 infection.
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Affiliation(s)
| | - Givago S. Souza
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Pará, Brazil
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brazil
| | | | - Luiz Carlos L. Silveira
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Pará, Brazil
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brazil
- Universidade do Ceuma, São Luís, Maranhão, Brazil
| | | | - Bianca Callegari
- Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém, Pará, Brazil
- * E-mail:
| | - Marília B. Xavier
- Universidade do Estado do Pará, Belém, Pará, Brazil
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Pará, Brazil
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Neurological manifestations in individuals with HTLV-1-associated myelopathy/tropical spastic paraparesis in the Amazon. Spinal Cord 2015; 54:154-7. [PMID: 26169165 DOI: 10.1038/sc.2015.112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 05/02/2015] [Accepted: 05/28/2015] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN A cross-sectional observational study was conducted. OBJECTIVE The aim was to analyze the clinical-functional profile of patients diagnosed with HTLV-1 (human T-lymphotropic virus type 1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in the Amazon region. SETTING Reference center for HTLV in the city of Belém, state of Pará, Brazil. METHODS Muscle strength, muscle tone, balance and the need for gait assistance among patients with HAM/TSP were evaluated. RESULTS Among the 82 patients infected with HTLV-1, 27 (10 men and 17 women) were diagnosed with HAM/TSP. No statistically significant difference in muscle tone or strength was found between the lower limbs. Muscle weakness and spasticity were predominant in the proximal lower limbs. Patients with HAM/TSP are at a high risk of falls (P=0.03), and predominantly use either a cane or a crutch on one side as a gait-assistance device (P=0.02). CONCLUSION Patients with HAM/TSP exhibit a similar clinical pattern of muscle weakness and spasticity, with a high risk of falls, requiring gait-assistance devices.
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Ishihara M, Araya N, Sato T, Saichi N, Fujii R, Yamano Y, Ueda K. A plasma diagnostic model of human T-cell leukemia virus-1 associated myelopathy. Ann Clin Transl Neurol 2015; 2:231-40. [PMID: 25815350 PMCID: PMC4369273 DOI: 10.1002/acn3.169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 12/09/2014] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Human T-cell leukemia virus-1 (HTLV-1) associated myelopathy/tropic spastic paraparesis (HAM/TSP) is induced by chronic inflammation in spinal cord due to HTLV-1 infection. Cerebrospinal fluid (CSF) neopterin or proviral load are clinically measured as disease grading biomarkers, however, they are not exactly specific to HAM/TSP. Therefore, we aimed to identify HAM/TSP-specific biomarker molecules and establish a novel less-invasive plasma diagnostic model for HAM/TSP. METHODS Proteome-wide quantitative profiling of CSFs from six asymptomatic HTLV-1 carriers (AC) and 51 HAM/TSP patients was performed. Fourteen severity grade biomarker proteins were further examined plasma enzyme-linked immunosorbent assay (ELISA) assays (n = 71). Finally, we constructed three-factor logistic regression model and evaluated the diagnostic power using 105 plasma samples. RESULTS Quantitative analysis for 1871 nonredundant CSF proteins identified from 57 individuals defined 14 CSF proteins showing significant correlation with Osame's motor disability score (OMDS). Subsequent ELISA experiments using 71 plasma specimens confirmed secreted protein acidic and rich in cysteine (SPARC) and vascular cell adhesion molecule-1 (VCAM-1) demonstrated the same correlations in plasma (R = -0.373 and R = 0.431, respectively). In this training set, we constructed a HAM/TSP diagnostic model using SPARC, VCAM1, and viral load. Sensitivity and specificity to diagnose HAM/TSP patients from AC (AC vs. OMDS 1-11) were 85.3% and 81.1%, respectively. Importantly, this model could be also useful for determination of therapeutic intervention point (OMDS 1-3 + AC vs. OMDS 4-11), exhibiting 80.0% sensitivity and 82.9% specificity. INTERPRETATION We propose a novel less-invasive diagnostic model for early detection and clinical stratification of HAM/TSP.
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Affiliation(s)
- Makoto Ishihara
- Division of Biosciences, Functional Proteomics Center, Graduate School of Frontier Sciences, The University of Tokyo Tokyo, Japan
| | - Natsumi Araya
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine Kawasaki, Japan
| | - Tomoo Sato
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine Kawasaki, Japan
| | - Naomi Saichi
- Division of Biosciences, Functional Proteomics Center, Graduate School of Frontier Sciences, The University of Tokyo Tokyo, Japan
| | - Risa Fujii
- Division of Biosciences, Functional Proteomics Center, Graduate School of Frontier Sciences, The University of Tokyo Tokyo, Japan
| | - Yoshihisa Yamano
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine Kawasaki, Japan
| | - Koji Ueda
- Division of Biosciences, Functional Proteomics Center, Graduate School of Frontier Sciences, The University of Tokyo Tokyo, Japan
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Britto VLSD, Correa R, Vincent MB. Proprioceptive neuromuscular facilitation in HTLV-I-associated myelopathy/tropical spastic paraparesis. Rev Soc Bras Med Trop 2014; 47:24-9. [DOI: 10.1590/0037-8682-0245-2013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/30/2014] [Indexed: 11/22/2022] Open
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Shoeibi A, Rafatpanah H, Azarpazhooh A, Mokhber N, Hedayati-Moghaddam MR, Amiri A, Hashemi P, Foroghipour M, Hoseini RF, Bazarbachi A, Azarpazhooh MR. Clinical features of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in northeast Iran. Acta Neurol Belg 2013; 113:427-33. [PMID: 23568138 DOI: 10.1007/s13760-013-0194-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 03/21/2013] [Indexed: 12/14/2022]
Abstract
This study aimed to introduce clinical manifestations of patients in northeast Iran with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and describe the epidemiological features, as well as risk factors for HTLV-1 infection. This is a cross-sectional study of HTLV-1 infected cases and HAM/TSP patients referred by outpatient neurology clinics as well as Mashhad Blood Transfusion Center from 2005 to 2010. The study comprises 513 cases, including 358 healthy carriers (HCs) and 145 HAM/TSP patients. The majority of carriers were male (73.5%), whereas 67.6% of HAM/TSP sufferers were female (P < 0.001). The mean age of HAM/TSP patients and HCs was 45.9 ± 13.6 and 39.5 ± 11.58 years, respectively (P < 0.001). The history of transfusion, surgery, hospitalization and cupping was observed in a significant greater number of HAM/TSP patients than the HCs (P < 0.001, P < 0.001, P < 0.001 and P = 0.029, respectively). Gait disturbance was the most common complaint in HAM/TSP patients (72.4%). This research develops an HTLV-1 data registry in an endemic area such as Mashhad which can serve useful purposes, including evaluation of clinical and laboratory characteristics of HAM/TSP patients and epidemiological data of HTLV-1-infected cases.
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Affiliation(s)
- Ali Shoeibi
- Department of Neurology, Faculty of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmadabad Boulevard, Mashhad, Iran
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Borges J, Baptista AF, Santana N, Souza I, Kruschewsky RA, Galvão-Castro B, Sá KN. Pilates exercises improve low back pain and quality of life in patients with HTLV-1 virus: a randomized crossover clinical trial. J Bodyw Mov Ther 2013; 18:68-74. [PMID: 24411152 DOI: 10.1016/j.jbmt.2013.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 04/15/2013] [Accepted: 05/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Low back pain is highly prevalent in patients with HTLV-1. The effects of physical activity on this condition are not known, but postural misalignment and motor deficits are frequently present. OBJECTIVES To assess the effect of Pilates exercises on chronic low back pain in these patients, and its impact on quality of life. METHODS A randomized crossover clinical trial was conducted, involving 22 patients from a reference center in Salvador, Bahia, Brazil. The VAS was used to evaluate the effect of Pilates on pain intensity and the SF-36 to assess its impact on quality of life. RESULTS Our results provide evidence of positive effects on pain intensity and almost all domains of quality of life when patients followed the Pilates exercise program described. CONCLUSION The Pilates method may be a useful tool in alleviating the symptoms of low back pain, and had a significant impact on quality of life in this sample of patients.
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Affiliation(s)
- Jaqueline Borges
- Escola Bahiana de Medicina e Saúde Pública, Post-graduation Program on Medicine and Human Health, Salvador, Bahia, Brazil; Escola Bahiana de Medicina e Saúde Pública, Neuromusculoskeletal Dynamics Research Group, Salvador, Bahia, Brazil
| | - Abrahão Fontes Baptista
- Escola Bahiana de Medicina e Saúde Pública, Post-graduation Program on Medicine and Human Health, Salvador, Bahia, Brazil; Universidade Federal da Bahia, Biomorphology Department, Salvador, Bahia, Brazil; Escola Bahiana de Medicina e Saúde Pública, Neuromusculoskeletal Dynamics Research Group, Salvador, Bahia, Brazil.
| | - Nayara Santana
- Escola Bahiana de Medicina e Saúde Pública, Neuromusculoskeletal Dynamics Research Group, Salvador, Bahia, Brazil
| | - Israel Souza
- Instituto Federal de Ciência e Tecnologia do Rio de Janeiro, Paracambi, Rio de Janeiro, Brazil
| | - Ramon A Kruschewsky
- Escola Bahiana de Medicina e Saúde Pública, Multidisciplinary Reference Center for HTLV and Human Retroviruses, Salvador, Bahia, Brazil
| | - Bernardo Galvão-Castro
- Escola Bahiana de Medicina e Saúde Pública, Post-graduation Program on Medicine and Human Health, Salvador, Bahia, Brazil; Escola Bahiana de Medicina e Saúde Pública, Multidisciplinary Reference Center for HTLV and Human Retroviruses, Salvador, Bahia, Brazil
| | - Katia Nunes Sá
- Escola Bahiana de Medicina e Saúde Pública, Post-graduation Program on Medicine and Human Health, Salvador, Bahia, Brazil; Escola Bahiana de Medicina e Saúde Pública, Neuromusculoskeletal Dynamics Research Group, Salvador, Bahia, Brazil; Escola Bahiana de Medicina e Saúde Pública, Multidisciplinary Reference Center for HTLV and Human Retroviruses, Salvador, Bahia, Brazil
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Falls in patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Spinal Cord 2012; 51:222-5. [PMID: 23165507 DOI: 10.1038/sc.2012.134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To determine the prevalence of falls in human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients and possible factors associated to their occurrence. SETTING Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ) - Brazil. METHODS Thirty-six HAM/TSP patients able to walk at least 20 m were assessed by a questionnaire. Data regarding gender, age, duration of disease (DD), HTLV-I proviral load (HPL), frequency of physical activity (FCA), use of walking aids, functional ambulation level, the number of falls and associated injuries in the last year were reviewed. Multiple correspondence analysis was used to group characteristics of this sample according to the fall occurrence. RESULTS The prevalence of falls was 63.9% and we observed injuries in 47.8% of the cases. Four groups were identified in the descriptive analysis. One group was formed by faller individuals, men <60 years, independent ambulation, FCA≥3 times per week and HPL <6.6 copies per 100 cells (group B). The other one comprised non-faller patients, women ≥60 years, restricted ambulation, DD ≥7 years, use of orthosis, FCA 0-1 time per week and HPL ≥6.6 copies per 100 cells (group D). The others two groups comprised individuals that did not use orthosis (group A) and those that FCA was two times per week and DD <7 years (group C). CONCLUSION Falls occur in roughly two-thirds of ambulatory HAM/TSP patients and are associated with significant morbidity. Further studies with a larger number of patients are necessarily to identify risk factors in order to elaborate specific programs to prevent falls in this population.
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Martins JVP, Baptista AF, Araújo ADQC. Quality of life in patients with HTLV-I associated myelopathy/tropical spastic paraparesis. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 70:257-61. [DOI: 10.1590/s0004-282x2012005000006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 11/23/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To assess the quality of life (QoL) of patients with HTLV-I-associate myelopathy/tropical spastic paraparesis (HAM/TSP) and to correlate it with specific aspects of the disease. METHODS: Fifty-seven HAM/TSP patients completed the SF-36 QoL questionnaire. They were also asked about common complaints related to the disease, and we looked for associations between QoL and these complaints. RESULTS: Patients with HAM/TSP showed a strong negative association to QoL. Pain was the condition which most affected their QoL. The practice of physical activity is associated with better QoL in five out of eight domains of the scale. CONCLUSION: HAM/TSP leads to a poor QoL, mostly influenced by pain. Physical activity may have a positive association to QoL of these patients.
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Shublaq M, Orsini M, Puccioni-Sohler M. Implications of HAM/TSP functional incapacity in the quality of life. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:208-11. [DOI: 10.1590/s0004-282x2011000200013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Accepted: 10/05/2010] [Indexed: 12/14/2022]
Abstract
OBJECTIVE: To identify the functional status and quality of life of HAM/TSP patients. METHOD: We evaluated prospectively 30 HAM/TSP patients (20 females) seen in the Neuroinfection Clinic of the HUGG. The functional capacity was analyzed by the functional independence measure (FIM), the expanded disability status (EDSS) scale and the Osame's motor disability score (OMDS). The quality of life was assed by the Short-Form Health Survey 36 (SF-36)TM. RESULTS: All patients need assistance device. The FIM, OMDS and EDSS scores classified 70%, 67% and 67% of the patients as dependent, respectively. The lowest scores of the SF-36 survey were found in the domains related to the physical health (D1, D2), role-emotional functioning (D7) and social functioning (D6). CONCLUSION: Our data suggest that the HAM/TSP physical impairment has an impact in the emotional and social issues, considering the limitation in the daily activities.
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Affiliation(s)
- Marcia Shublaq
- University of State of Rio de Janeiro, Brazil; Centro Universitário da Cidade, Brazil
| | - Marco Orsini
- Federal Fluminense University; Grande Rio University, Brazil
| | - Marzia Puccioni-Sohler
- University of State of Rio de Janeiro, Brazil; Federal University of Rio de Janeiro, Brazil
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Miyazaki M, Sakakima H, Goto T, Kiyama R, Matsuzaki T, Ijiri K, Yoshida Y. Isokinetic trunk and knee muscle strengths and gait performance in walking patients with T-cell lymphotropic virus type 1-associated myelopathy/ tropical spastic paraparesis (HAM/TSP). JOURNAL OF THE JAPANESE PHYSICAL THERAPY ASSOCIATION 2011; 14:19-26. [PMID: 25792894 DOI: 10.1298/jjpta.vol14_003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 10/03/2011] [Indexed: 11/23/2022]
Abstract
The aim of this study was to investigate the isokinetic trunk and knee muscle strengths, and examine the clinical relevance of dynamic muscle strengths and gait performance in walking patients with human T-cell lymphotropic virus type 1-associated myelopathy/ tropical spastic paraparesis (HAM/TSP). Thirteen patients with HAM/TSP (8 females and 5 males, aged 38-76) and 13 sex- and age-matched healthy control subjects participated in the study. We assessed gait speed, stride length, cadence; and maximal isokinetic torque of trunk and knee extensors and flexors at 30°/s, 60°/s and 90°/s using a Biodex System 3 dynamometer. Furthermore, we calculated the isokinetic trunk extensor/flexor (E/F) and hamstrings/quadriceps (H/Q) strength ratios (parameter of the muscle strength balance about the trunk and knee joint). Compared with the age-matched controls, the patients with HAM/TSP had significantly reduced gait speed, stride length and cadence (P < 0.05). Peak torque values related to body weight (PTBW) were significantly reduced, especially for the knee flexors (P < 0.05). For the knee extensors, the PTBW values were significantly reduced at an increased angular velocity (P < 0.05). The PTBW of knee flexors was positively correlated with gait speed and cadence in the patients with HAM/TSP. The H/Q ratio but not E/F ratio was significantly decreased compared with the control. Our results indicated that the isokinetic trunk and knee muscle performance had reduced from the ambulatory stage, and suggested the deterioration in knee muscle performance to be associated with gait disturbance in walking HAM/TSP patients.
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Affiliation(s)
- Masashi Miyazaki
- School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Harutoshi Sakakima
- School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Tatsushi Goto
- School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Ryoji Kiyama
- School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | | | - Kosei Ijiri
- Department of Orthopaedic Surgery, Kagoshima University
| | - Yoshihiro Yoshida
- School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
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Low-back pain in HTLV-I-associated myelopathy/tropical spastic paraparesis: nociceptive or neuropathic? Spinal Cord 2009; 48:134-7. [DOI: 10.1038/sc.2009.83] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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