Treino de dupla tarefa e ETCC reduzem a assimetria da marcha na Doença de Parkinson?

Autores

DOI:

https://doi.org/10.34024/rnc.2024.v32.18987

Palavras-chave:

Treinamento de dupla tarefa, Estimulação Transcraniana por Corrente Contínua, Análise da Marcha, Doença de Parkinson, Modalidades de Fisioterapia

Resumo

Introdução. A assimetria da marcha é uma característica ainda pouco compreendida da Doença de Parkinson (DP). O treinamento de Dupla Tarefa (DT) e a Estimulação Transcraniana por Corrente Contínua (ETCC) são intervenções que, ultimamente, vem sendo utilizadas no manejo das disfunções da marcha na DP. Este estudo tem como objetivo analisar o impacto do treino de DT na esteira associado ao uso da ETCC na assimetria da marcha em diferentes atividades de DT na DP. Método. Trata-se de um estudo observacional realizado a partir de um ensaio clínico. 16 participantes com DP foram alocados em dois grupos: Grupo Controle (n=8) - ETCC e treino de marcha em esteira; Grupo Experimental (n=8) - ETCC, treino de marcha em esteira e treino de DT motora e cognitiva. O protocolo foi composto por 3 sessões semanais com duração de 4 semanas. O índice de assimetria (IAS) do comprimento e tempo do passo foi avaliado antes e após a intervenção em 4 diferentes tarefas: marcha sem DT, com DT cognitiva 1 (memória), DT cognitiva 2 (fluência verbal) e DT motora. Resultados. Não houve redução significante do IAS do comprimento e tempo do passo em nenhum dos grupos após as intervenções realizadas, nem diferença entre os tipos de marcha. Conclusão. O IAS do comprimento e do tempo do passo podem ser desfechos da marcha pouco sensíveis às intervenções propostas por este estudo e pouco alteradas em situações de DT quando comparadas à marcha habitual.

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Referências

García-López H, Los Ángeles Castillo-Pintor M, Castro-Sánchez AM, Lara-Palomo IC, Obrero-Gaitán E, Cortés-Pérez I. Efficacy of Dual-Task Training in Patients with Parkinson's Disease: A Systematic Review with Meta-Analysis. Mov Disord Clin Pract 2023;10:1268-84. https://doi.org/10.1002/mdc3.13823

Mirelman A, Bonato P, Camicioli R, Ellis TD, Giladi N, Hamilton JL, et al. Gait impairments in Parkinson's disease. Lancet Neurol 2019;18:697-708. https://doi.org/10.1016/S1474-4422(19)30044-4

Godi M, Arcolin I, Giardini M, Corna S, Schieppati M. A pathophysiological model of gait captures the details of the impairment of pace/rhythm, variability and asymmetry in Parkinsonian patients at distinct stages of the disease. Sci Rep 2021;11:21143. https://doi.org/10.1038/s41598-021-00543-9

Frazzitta G, Pezzoli G, Bertotti G, Maestri R. Asymmetry and freezing of gait in parkinsonian patients. J Neurol 2013;260:71-6. https://doi.org/10.1007/s00415-012-6585-4

Ribeiro TS, Sousa AC, Lucena LC, Santiago LMM, Lindquist AR. Does dual task walking affect gait symmetry in individuals with Parkinson’s disease? Eur J Physiother 2019;21:8-14. https://doi.org/10.1080/21679169.2018.1444086

Yogev G, Plotnik M, Peretz C, Giladi N, Hausdorff JM. Gait asymmetry in patients with Parkinson's disease and elderly fallers: when does the bilateral coordination of gait require attention? Exp Brain Res 2007;177:336-46. https://doi.org/10.1007/s00221-006-0676-3

Yogev-Seligmann G, Hausdorff JM, Giladi N. The role of executive function and attention in gait. Mov Disord 2008;23:329-472. https://doi.org/10.1002/mds.21720

Ehgoetz Martens KA, Peterson DS, Almeida QJ, Lewis SJG, Hausdorff JM, Nieuwboer A. Behavioural manifestations and associated non-motor features of freezing of gait: A narrative review and theoretical framework. Neurosci Biobehav Rev 2020;116:350-64. https://doi.org/10.1016/j.neubiorev.2020.06.026

Strouwen C, Molenaar EA, Münks L, Keus SH, Bloem BR, Rochester L, et al. Dual tasking in Parkinson's disease: should we train hazardous behavior? Rev Neurother 2015;15:1031-9. https://doi.org/10.1586/14737175.2015.1077116

Hoehn MM, Yahr MD. Parkinsonism: onset, progression, and mortality. Neurology 1998;50:318. https://doi.org/10.1212/wnl.50.2.318

Geroin C, Nonnekes J, de Vries NM, Strouwen C, Smania N, Tinazzi M, et al. Does dual-task training improve spatiotemporal gait parameters in Parkinson's disease? Parkinsonism Relat Disord 2018;55:86-91. https://doi.org/10.1016/j.parkreldis.2018.05.018

Mishra RK, Thrasher AT. Transcranial direct current stimulation of dorsolateral prefrontal cortex improves dual-task gait performance in patients with Parkinson's disease: A double blind, sham-controlled study. Gait Posture 2021;84:11-6. https://doi.org/10.1016/j.gaitpost.2020.11.012

Wong PL, Yang YR, Huang SF, Fuh JL, Chiang HL, Wang RY. Transcranial Direct Current Stimulation on Different Targets to Modulate Cortical Activity and Dual-Task Walking in Individuals With Parkinson's Disease: A Double Blinded Randomized Controlled Trial. Front Aging Neurosci 2022;14:807151. https://doi.org/10.3389/fnagi.2022.807151

Pol F, Salehinejad MA, Baharlouei H, Nitsche MA. The effects of transcranial direct current stimulation on gait in patients with Parkinson's disease: a systematic review. Transl Neurodegener 2021;10:22. https://doi.org/10.1186/s40035-021-00245-2

Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE. Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. Gait Posture 2010;31:241-6. https://doi.org/10.1016/j.gaitpost.2009.10.014

Costa-Ribeiro A, Andrade SMMDS, Férrer MLV, Silva OAPD, Salvador MLS, Smaili S. Can Task Specificity Impact tDCS-Linked to Dual Task Training Gains in Parkinson's Disease? A Protocol for a Randomized Controlled Trial. Front Aging Neurosci 2021;13:684689. https://doi.org/10.3389/fnagi.2021.684689

Serrao M, Chini G, Caramanico G, Bartolo M, Castiglia SF, Ranavolo A, et al. Prediction of Responsiveness of Gait Variables to Rehabilitation Training in Parkinson's Disease. Front Neurol 2019;10:826. https://doi.org/10.3389/fneur.2019.00826

Plotnik M, Hausdorff JM. The role of gait rhythmicity and bilateral coordination of stepping in the pathophysiology of freezing of gait in Parkinson's disease. Mov Disord. 2008;23(Suppl 2):S444-50. https://doi.org/10.1002/mds.21984

Plotnik M, Giladi N, Hausdorff JM. Is freezing of gait in Parkinson's disease a result of multiple gait impairments? Implications for treatment. Parkinsons Dis 2012;2012:459321. https://doi.org/10.1155/2012/459321

Schabrun SM, Lamont RM, Brauer SG. Transcranial Direct Current Stimulation to Enhance Dual-Task Gait Training in Parkinson's Disease: A Pilot RCT. PLoS One 2016;11:e0158497. https://doi.org/10.1371/journal.pone.0158497

Li Z, Wang T, Liu H, Jiang Y, Wang Z, Zhuang J. Dual-task training on gait, motor symptoms, and balance in patients with Parkinson’s disease: a systematic review and meta-analysis. Clin Rehab 2020;34:1355-67. https://doi.org/10.1177/0269215520941142

Johansson H, Ekman U, Rennie L, Peterson DS, Leavy B, Franzén E. Dual-Task Effects During a Motor-Cognitive Task in Parkinson's Disease: Patterns of Prioritization and the Influence of Cognitive Status. Neurorehabil Neural Repair 2021;35:356-66. https://doi.org/10.1177/1545968321999053

Son M, Han SH, Lyoo CH, Lim JA, Jeon J, Hong KB, et al. The effect of levodopa on bilateral coordination and gait asymmetry in Parkinson's disease using inertial sensor. NPJ Parkinsons Dis 2021;7:42. https://doi.org/10.1038/s41531-021-00186-7

Mondal B, Choudhury S, Banerjee R, Chatterjee K, Ghosal S, Anand SS, et al. Analysis of gait in Parkinson’s disease reflecting the effect of l-DOPA. Ann Movem Disord 2019;2:21-7. https://doi.org/10.4103/AOMD.AOMD_19_18

Plotnik M, Giladi N, Balash Y, Peretz C, Hausdorff JM. Is freezing of gait in Parkinson's disease related to asymmetric motor function? Ann Neurol 2005;57:656-63. https://doi.org/10.1002/ana.20452

Zirek E, Ersoz Huseyinsinoglu B, Tufekcioglu Z, Bilgic B, Hanagasi H. Which cognitive dual-task walking causes most interference on the Timed Up and Go test in Parkinson's disease: a controlled study. Neurol Sci 2018;39:2151-7. https://doi.org/10.1007/s10072-018-3564-2

Raffegeau TE, Krehbiel LM, Kang N, Thijs FJ, Altmann LJP, Cauraugh JH, et al. A meta-analysis: Parkinson's disease and dual-task walking. Parkinsonism Relat Disord 2019;62:28-35. https://doi.org/10.1016/j.parkreldis.2018.12.012

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2024-10-24

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1.
Dias VO, Medeiros Oliveira I, Gomes Mourão F, Rodrigues Lindquist AR, Cunha do Espirito Santo C, Marques de Melo Santiago L. Treino de dupla tarefa e ETCC reduzem a assimetria da marcha na Doença de Parkinson?. Rev Neurocienc [Internet]. 24º de outubro de 2024 [citado 14º de dezembro de 2025];32:1-20. Disponível em: https://periodicos.unifesp.br/index.php/neurociencias/article/view/18987
Recebido 2024-07-01
Aprovado 2024-10-08
Publicado 2024-10-24