Association Degree of Physical Disability and Postural Control in Subjects with Leprosy

Transcription

1 Larissa A. P. Viveiro Carolina M. Carmo Catarina C. Boffino Clarice Tanaka* Association Degree of Physical Disability and Postural Control in Subjects with Leprosy *Full Professor Department of Physical Therapy, Communication Science & Disorders, Occupational Therapy Faculty of Medicine USP Serviço de Fisioterapia ICHC

2 Postural Control Task P Individual Environment Horak F.B., Clinical assessment of balance disorders. Gait & Posture 6 (1997) 76-84

3 Postural Control Sensory Integration Individual Weighing Sensory Task Environment Cognition Perception I Action Vision 20% P Vestibular Proprioception 10% 70% Horak F.B., Clinical assessment of balance disorders. Gait & Posture 6 (1997) 76-84

4 Postural Control Body Balance Static Equilibrium Dynamic Equilibrium Shumway-Cook A, Woollacott M. Controle Postural Normal in. Controle Motor: Teoria e aplicações Práticas. 2 ed. Barueri, SP: Manole; 2003.p

5 Stability Limits Anticipatory and Compensatory Adjustments Shumway-Cook A, Woollacott M. Controle Postural Normal in. Controle Motor: Teoria e aplicações Práticas. 2 ed. Barueri, SP: Manole; 2003.p

6 Leprosy alterations Postural Control Vision Vestibular Proprioception Objective To correlate the degree of physical disability and postural control in subjects with leprosy. Stoner, G.L. (1979). Shetty, V.P., Antia, N.H., and Jacobs, J.M. (1988)

7 Methods 24 Subjects with leprosy Age = 43.88±11.96 years old (24 to 60 years old) BMI=28.61±3.85 kg/cm 2 Diagnosis Time = 5.33±4.11 years 19 men 79.2% 5 women 20.8%

8 Methods Degree of Physical Disabilty Eyes Lower Limbs Degree of Physical Disability Brasil. Ministério da Saúde. Capacitação em prevenção de incapacidades em hanseníase : caderno do monitor, 2010

9 Methods Stable Force Plate Condition 1 Eyes Open Normal Condition Condition 2 Eyes Closed No Vision Mobile Force Plate Quiet stance on a force plate 100Hz (Pro Balance Master 8.1.0) Three 20-second trials in four sensory conditions: Condition 3 Eyes Open Inaccurate Proprioception Condition 4 Eyes Closed Accurate Vestibular only

10 Methods Force Plate (100Hz) Data representation Area of CP displacement (A) Variables Velocity of CP forward-backward displacement (Vx) CPx=(-h.Fx-My)/Fz CPy=(-h.Fv+Mx)/Fz Velocity of CP side-to-side displacement (Vy)

11 Methods Sensorial contribution to the postural control Postural Control Degree of Physical Disability visual quotient (VQ): condition 2/1 proprioceptive quotient (PQ): condition 3/1 Area VQ, PQ, VestQ Left lower limb vestibular quotient (VestQ): condition 4/1 Vx VQ, PQ, VestQ x Right lower limb Left eye Vy VQ, PQ, VestQ Right eye Spearman Correlation p<0.05

12 Results ratio VQ, PQ, VestQ Area Vx Expected sensorial contribution Area MVx MVy Vy Proprioception (70%) Visual (20%) Vestibular (10%)

13 Results Degree of Physical Disability Left Lower Limb Right Lower Limb Left Eye 0 I II Right Eye 0 20% 40% 60% 80% 100%

14 Results Postural Control Degree of Physical Disability Area VQ, PQ, VestQ Vx VQ, PQ, VestQ x Left lower limb Right lower limb Left eye p=0.014 r=0.493 Vy VQ, PQ, VestQ Right eye

15 Discussion Area of CP displacement Area representation of leprosy subject (red) and healthy subject (blue) in the normal sensory condition.

16 Conclusion Subjects in our sample showed association between the degree of physical disability of right lower limb and Vx. As right lower limb presented only 25% of degree II of physical disability, the sensitivity of this tool was probably not enough to explain their postural alterations.

17 Effect of Proprioception in Postural Control in Children and Adults Souza, F.M.B. ; Pereira, R.P.R.; Carmo, C.M. ; Mello, M.H.M. ; Villaça, P.R.; Minuque, N. P. ;Tanaka, C. Postural adjustment after an unexpected perturbation in children with haemophilia. Haemophilia (Oxford. Print), v. 18, p. e311-e315, Barbosa, A ; Raggi, G.C. ; SÁ, C.S.C. ; Costa, M.P. ; Lima Jr, J. ; Tanaka C.. Postural control in women with breast hypertrophy. Clinics (USP. Impresso), v. 67, p , Cunha, A.G.J.; Nunes, M. P. T.; Ramos, R. T.; Carvalho Pinto, R. M.; Boffino, C. C.; Martins, F. C.; Tanaka, C. Balance Disturbances in Asthmatic Patients. Journal of Asthma, v.50, p , Souza, F. M. B. ; Mclaughlin, P. ; Pereira, R. P. ; Minuque, N. P. ; Mello, M. H. M. ; Siqueira, C. ; Villaça, P.;Tanaka, C. The effects of repetitive haemarthrosis on postural balance in children with haemophilia. Haemophilia (Oxford. Print), v. x, p. n/a-n/a, Barbosa, A. F. ; Raggi, GC ; SA, C. S. C. ; Costa, MP ; Lima JR, J. E. ; Tanaka, C. The Impact of Surgical Breast Reduction on the Postural Control of Women with Breast Hypertrophy. Aesthetic Plastic Surgery, v. 37, p , 2013.