Therapeutic effects of virtual reality video gaming on functional mobility, balance, and gait speed in individuals with tropical spastic paraparesis: A randomized crossover clinical trial

Abstract INTRODUCTION: Individuals with human T-cell lymphotropic virus 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) experience sensorimotor alterations, which can affect functional performance. Virtual reality (VR) videogaming is a therapeutic option, though there is scarce evidence for its use in this population. We aimed to investigate the therapeutic effects of a VR video game on functional mobility, balance, and gait speed in individuals with HAM/TSP. METHODS: We conducted a blinded, crossover clinical trial comprising 29 individuals with HAM/TSP and randomized them into two groups: (1) early therapy: rehabilitative protocol started immediately after the initial evaluation and (2) late therapy: rehabilitative protocol started 10 weeks later. We assessed all participants for balance using the Berg Balance Scale (BBS) scores, functional mobility using the Timed Up and Go (TUG) test, and gait speed using video camera and CvMob software. Differences were considered significant if p<0.05. RESULTS: The early therapy group individuals presented with higher BBS scores (p=0.415), less TUG times (p=0.290), and greater gait speed (p=0.296) than the late therapy group individuals. CONCLUSIONS: VR videogaming is a useful option for rehabilitative therapy in individuals with HAM/TSP; it positively affects balance, functional mobility, and gait speed.

Proprioceptive neuromuscular facilitation in HTLV-I-associated myelopathy/tropical spastic paraparesis

Introduction: Human T cell lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) can impact the independence and motricity of patients. The aims of this study were to estimate the effects of physiotherapy on the functionality of patients with HAM/TSP during the stable phase of the disease using proprioceptive neuromuscular facilitation (PNF) and to compare two methods of treatment delivery. Methods: Fourteen patients with human T cell lymphotropic virus type I (HTLV-I) were randomly allocated into two groups. In group I (seven patients), PNF was applied by the therapist, facilitating the functional activities of rolling, sitting and standing, walking and climbing and descending stairs. In group II (seven patients), PNF was self-administered using an elastic tube, and the same activities were facilitated. Experiments were conducted for 1h twice per week for 12 weeks. Low-back pain, a modified Ashworth scale, the functional independence measure (FIM) and the timed up and go test (TUG) were assessed before and after the interventions. Results: In the within-group evaluation, low-back pain was significantly reduced in both groups, the FIM improved in group II, and the results of the TUG improved in group I. In the inter-group analysis, only the tone was lower in group II than in group I. Conclusions: Both PNF protocols were effective in treating patients with HAM/TSP. .

Estudo clínico controlado randomizado aberto com metilprednisolona na mielopatia associada ao vírus tipo 1 linfotrópico de células T humanas/paraparesia espástica tropical / Clinical controlled randomized open trial with methylprednisolone in human T linphotropic virus type 1 associated/myelopathy and tropical spastic paraparesis

Introdução. Doença associada ao vírus tipo 1 linfotrópico de células T humanas ou paraparesia espástica tropical é uma mielopatia caracterizada por início insidioso, com fraqueza nas extremidades dos membros inferiores, seguida por espasticidade e ou hiperreflexia global, disfunção esfincteriana vesical e intestinal e perda sensorial variável. Objetivo. Avaliar a eficácia do tratamento com metilprednisolona em altas doses, em relação ao tempo de evolução e apresentação clínica de pacientes com a doença. Método. Estudou-se a avaliação clínica de longo termo (t = 24 meses) da resposta de treze pacientes com diagnóstico precoce do quadro ao tratamento com metilprednisolona em esquema mensal de administração (1 g/dia por três dias), por seis meses consecutivos, com atendimento em hospital-dia. Foi realizado o acompanhamento dos pacientes, usando-se como parâmetros as escalas de critérios clínicos de Osame e Kurtzke, e comparou-se com um grupo-controle pareado por sexo, idade e quadro clínico (n = 13), que não recebeu esse tipo de tratamento. Resultados. O resultado do teste estatístico de Mann-Whitney para o índice final das escalas de Osame e Kurtzke foi p = 0,1688 (Delta t = 24 meses). Aplicou-se novamente o teste estatístico de Mann-Whitney às diferenças entre o índice final e inicial das escalas citadas acima, que resultou em p = 0,0154. O intervalo de confiança foi 95%, médiade 0,18 a 1,37. O qui ao quadrado (Yates, corrigido) foi 0,28. O risco relativo foi 0,5. Conclusão. Não houve diferença na manutenção do grau de incapacidade entre o grupo experimental e o grupo de controle. A fisioterapia foi um fator de proteção à estabilidade do grau de incapacidade entre os pacientes com a mielopatia em estudo.

Background. Human T linphotropic virus type 1 associated with myelopathy or tropical spastic paraparesis is a myelopathy characterized by insidious onset with weakness in the extremities of the inferior members, followed by spasticity, global hiperreflexy and dysfunction sensorial loss. Objective. The aim was to study the treatment with methylprednisolone in high doses, in relation to the time of evolution and presentation of the disease and its effectiveness. Methods. We studied the long term clinical response of patients with early diagnoses of human T linphotropic virus type 1 associated with myelopathy or tropical spastic paraparesis to treatment with methylprednisolone in a monthly scheme of administration (1 g/day for three days) for six months. The patients were followed during 24 months using as parameters the scales of clinical criteria by Osame and Kurtzke and compared with a control group of patients who did not receive this treatment type. Results. Mann-Whitney for the final score is p = 0.1688 (delta t = 24 months) and Mann-Whitney for the differences between the final and the initial scores is p = 0.0154. Confidence interval of 95% ranged from 0.18 to 1.37. Chi-square (Yates, corrected) was 0.28. Relative risk was 0.5. Conclusion. There is no difference in the maintenance of the degree of disability between experimental group and control group. The physiotherapy is a protection factor for the stability of the degree of disability among patients with the disease.

Guia de manejo clínico do paciente com HTLV: aspectos neurológicos / Guide of clinical management of HTLV patient: neurological aspects

O Ministério da Saúde (Programa DST e Aids) reuniu especialistas para elaborar um guia informativo de manejo do paciente com HTLV. Dentre os diferentes tópicos, foram contemplados os aspectos neurológicos associados à infecção pelo HTLV. Um caso suspeito de doença neurológica associada ao HTLV deve incluir alteração de força e reflexos, parestesias distais e disfunção autonômica. A investigação do caso suspeito deve ser baseada na síndrome exibida pelo paciente. Para o paciente com síndrome medular, deve-se solicitar ressonância magnética da medula ou mielografia, assim como, estudo do líquor. Para o paciente com síndrome neuropática ou miopática, deve-se solicitar eletroneuromiografia e dosagem de CPK, e para aquele com síndrome autonômica, pesquisa de hipotensão postural, ultrassonografia das vias urinárias e estudo urodinâmico. O tratamento pode ser sintomático (espasticidade, bexiga neurogênica, constipação intestinal e dor neuropática) e específico a ser feito em centros especializados.

Paraparesia espástica tropical (ou mielopatia associada ao retrovírus HTLV-I - PET/MAH) / Tropical spastic paraparesis (or HTLV-I associated myelopathy - TSP/HAM)

A paraparesia espástica tropical (PET/MAH) é uma mielopatia associada em grande parte ao retrovírus HTLV-I, que pertence à família Retroviridade e subfamília Oncovirinae. Esse vírus é prevalente no Japão, Caribe, América do Sul, África e Melanésia , e no mundo existem cerca de 20 milhões de indivíduos infectados e mais de 2000 casos descritos de PET/MAH. O diagnóstico da infecção é feito por testes sorológicos ( Elisa, descritos de PET/MAH. O diagnóstico da infecção é feito por testes sorológicos ( (Elisa Western blot e mais recentemente INNO-LIA) e moleculares (PCR). Clinicamente , a PET/MAH se caracteriza por uma paraparesia espástica insidiosamente progressiva associada a variáveis distúrbios esfincterianos e sensitivos. Os critérios diagnósticos foram propostos pela OMS e têm sido usado como guia na definição clínica e laboratorial . tais como LCR, estudo de potenciais evocados somatossentivos e ressonância nuclear magnética, têm sido utilizados para confirmação e diagnóstico diferencial da PET/MAH. Do ponto de vista neuropatológico, a PET/MAH apresenta lesões inflamatórias e desmielinizantes centradas principalmente na medula torácica baixa.As hipóteses fisiopagênicas atuais apontam para mecanismos imunológicos, de onde tentativas terapêuticas pertinentes advêm.

Mielopatia associada ao vírus linfotrópico humano de cÚlulas T do tipo 1 (HTLV-1) / Human T-cell lymphotropic virus type 1(HTLV-1)-associated myelopathy

HTLV-1-associated myelopathy (HAM), also known as tropical spastic paraparesis (TSP), is a chronic progressive demyelinating disease that affects the spinal cord and white matter of the central nervous system. The lifetime incidence of HAM in HTLV-1 carriers is estimated to be less than 5. Typical time of onset is in the fourth decade of life, with a female-to-male rate of 2:1. Gait disturbance and weakness and stiffness of the lower limbs are common presenting signs and symptoms of HAM. Lower extremities are affected to a much greater degree than upper extremities. Spasticity may be moderate to severe, and lower back pain is common. As the disease progresses, bladder and bowel dysfunction can occur. Sensory involvement is generally mild and can result in a variable degree of sensory loss and dysesthesia. Results of magnetic resonance imaging may be normal, or the scans show atrophy of the spinal cord and nonspecific lesions in the brain. Immunologic evidence suggests that an immune mechanism may play a role in the development of HAM. There is no effective treatment for the myelopathy. Corticosteroids, and INF-gamma may produce transient responses. Danazol, an anabolic steroid, does not improve gait and bladder function. The value of zidovudine (anti-retroviral agent) in the treatment has not been defined yet.

Mielopatia Associada ao HTLV-1 (Paraparesia Espástica Tropical) / HTLV-1 Associated Myelopathy (Tropical Spastic Parapareses)

Desde maio de 1990 a mielopatia associada ao HTLV-1 vem sendo investigada no Recife. Mais dois casos, com estudo por ressonância magnética, são relatados

Paraparesia espástica tropical / Tropical spastic paraparesis

La Paraparesia Espástica Tropical es una mielopatía que afecta principalmente el tracto corticoespinal, con poca afectación del sistema sensorial, caracterizada por un inicio gradual, con curso y lentamente progresivo, sin remision espontánea. Recientemente se ha implicado al virus HTLV-1 como el agente causal de esta mielopatía. Se presenta caso clínico de un paciente masculino de 32 años de edad quien consulta con alteracines neurológicas y compromiso del esfínter vesical. Posterior a diversos estudios se encuentra anticuerpos contra HTLV-1 en una muestra de LCR, del paciente, con bandas policlonales de inmunoglobulinas en el mismo