Autonomic Modulation in Duchenne Muscular Dystrophy During a Computer Task: A Prospective Transversal Controlled Trial Assessment by Non-linear Techniques.

Introduction: Due to functional and autonomic difficulties faced by individuals with Duchenne Muscular Dystrophy (DMD), the use of assistive technology is critical to provide or facilitate functional abilities. The key objective was to investigate acute cardiac autonomic responses, by application of Heart Rate Variability (HRV), during computer tasks in subjects with DMD via techniques based on non-linear dynamics. Method: HRV was attained via a Polar RS800CX. Then, was evaluated by Chaotic Global Techniques (CGT). Forty-five male subjects were included in the DMD group and age-matched with 45 in the healthy Typical Development (TD) control group. They were assessed for 20 min at rest sitting, and then 5 min whilst performing the maze task on a computer. Results: Both TD and DMD subjects exhibited a significantly reduced HRV measured by chaotic global combinations when undertaking the computer maze paradigm tests. DMD subjects presented decreased HRV during rest and computer task than TD subjects. Conclusion: While there is an impaired HRV in subjects with DMD, there remains an adaptation of the ANS during the computer tasks. The identification of autonomic impairment is critical, considering that the computer tasks in the DMD community may elevate their level of social inclusion, participation and independence.

Influence of Different Types of Corticosteroids on Heart Rate Variability of Individuals with Duchenne Muscular Dystrophy-A Pilot Cross Sectional Study.

Individuals with Duchenne Muscular Dystrophy (DMD) have an impairment of cardiac autonomic function categorized by parasympathetic reduction and sympathetic predominance. The objective of this study was to assess the cardiac autonomic modulation of individuals with DMD undergoing therapy with Prednisone/Prednisolone and Deflazacort and compare with individuals with DMD without the use of these medications and a typically developed control group. Methods: A cross-sectional study was completed, wherein 40 boys were evaluated. The four treatment groups were: Deflazacort; Prednisone/Prednisolone; no corticoid use; and typical development. Heart Rate Variability (HRV) was investigated via linear indices (Time Domain and Frequency Domain) and non-linear indices Results: The results of this study revealed that individuals with DMD undertaking pharmacotherapies with Prednisolone demonstrated HRV comparable to the Control Typically Developed (CTD) group. In contrast, individuals with DMD undergoing pharmacotherapies with Deflazacort achieved lower HRV, akin to individuals with DMD without any medications, as demonstrated in the metrics: RMSSD; LF (n.u.), HF (n.u.), LF/HF; SD1, α1, and α1/α2, and a significant effect for SD1/SD2; %DET and Ratio; Shannon Entropy, 0 V%, 2 LV% and 2 ULV%. Conclusions: Corticosteroids have the potential to affect the cardiac autonomic modulation in adolescents with DMD. The use of Prednisone/Prednisolone appears to promote improved responses in terms of sympathovagal activity as opposed to Deflazacort.

Achievement of Virtual and Real Objects Using a Short-Term Motor Learning Protocol in People with Duchenne Muscular Dystrophy: A Crossover Randomized Controlled Trial.

OBJECTIVE: To evaluate whether people with Duchenne muscular dystrophy (DMD) practicing a task in a virtual environment could improve performance given a similar task in a real environment, as well as distinguishing whether there is transference between performing the practice in virtual environment and then a real environment and vice versa. METHODS: Twenty-two people with DMD were evaluated and divided into two groups. The goal was to reach out and touch a red cube. Group A began with the real task and had to touch a real object, and Group B began with the virtual task and had to reach a virtual object using the Kinect system. RESULTS: ANOVA showed that all participants decreased the movement time from the first (M = 973 ms) to the last block of acquisition (M = 783 ms) in both virtual and real tasks and motor learning could be inferred by the short-term retention and transfer task (with increasing distance of the target). However, the evaluation of task performance demonstrated that the virtual task provided an inferior performance when compared to the real task in all phases of the study, and there was no effect for sequence. CONCLUSIONS: Both virtual and real tasks promoted improvement of performance in the acquisition phase, short-term retention, and transfer. However, there was no transference of learning between environments. In conclusion, it is recommended that the use of virtual environments for individuals with DMD needs to be considered carefully.

Improvements in motor tasks through the use of smartphone technology for individuals with Duchenne muscular dystrophy.

BACKGROUND: In individuals severely affected with Duchenne muscular dystrophy (DMD), virtual reality has recently been used as a tool to enhance community interaction. Smartphones offer the exciting potential to improve communication, access, and participation, and present the unique opportunity to directly deliver functionality to people with disabilities. OBJECTIVE: To verify whether individuals with DMD improve their motor performance when undertaking a visual motor task using a smartphone game. PATIENTS AND METHODS: Fifty individuals with DMD and 50 healthy, typically developing (TD) controls, aged 10-34 years participated in the study. The functional characterization of the sample was determined through Vignos, Egen Klassifikation, and the Motor Function Measure scales. To complete the task, individuals moved a virtual ball around a virtual maze and the time in seconds was measured after every attempt in order to analyze improvement of performance after the practice trials. Motor performance (time to finish each maze) was measured in phases of acquisition, short-term retention, and transfer. RESULTS: Use of the smartphone maze game promoted improvement in performance during acquisition in both groups, which remained in the retention phase. At the transfer phases, with alternative maze tasks, the performance in DMD group was similar to the performance of TD group, with the exception of the transfer to the contralateral hand (nondominant). However, the group with DMD demonstrated longer movement time at all stages of learning, compared with the TD group. CONCLUSION: The practice of a visual motor task delivered via smartphone game promoted an improvement in performance with similar patterns of learning in both groups. Performance can be influenced by task difficulty, and for people with DMD, motor deficits are responsible for the lower speed of execution. This study indicates that individuals with DMD showed improved performance in a short-term motor learning protocol using a smartphone. We advocate that this technology could be used to promote function in this population.

Autonomic Modulation in Duchenne Muscular Dystrophy during a Computer Task: A Prospective Control Trial.

INTRODUCTION: Duchenne Muscular Dystrophy (DMD) is characterized by progressive muscle weakness that can lead to disability. Owing to functional difficulties faced by individuals with DMD, the use of assistive technology is essential to provide or facilitate functional abilities. In DMD, cardiac autonomic dysfunction has been reported in addition to musculoskeletal impairment. Consequently, the objective was to investigate acute cardiac autonomic responses, by Heart Rate Variability (HRV), during computer tasks in subjects with DMD. METHOD: HRV was assessed by linear and nonlinear methods, using the heart rate monitor Polar RS800CX chest strap Electrocardiographic measuring device. Then, 45 subjects were included in the group with DMD and 45 in the healthy Typical Development (TD) control group. They were assessed for twenty minutes at rest sitting, and five minutes after undergoing a task on the computer. RESULTS: Individuals with DMD had a statistically significant lower parasympathetic cardiac modulation at rest when compared to the control group, which further declined when undergoing the tasks on the computer. CONCLUSION: DMD patients presented decreased HRV and exhibited greater intensity of cardiac autonomic responses during computer tasks characterized by vagal withdrawal when compared to the healthy TD control subjects.

Analysis of psychomotor development and level of physical activity of children with extracurricular physical activities / Análise do desenvolvimento psicomotor e nível de atividade física de crianças em atividades físicas extracurriculares

Objective: The objective was to evaluate the psychomotor development in the areas of global motor skills, balance and body structure and level of school extracurricular physical activity. Method: The sample consisted of 30 individuals of both sexes from 6 to 10 years old, divided into two groups: Active Extracurricular Group and Sedentary Extracurricular Group. Data collection included the characterization of the subjects, anthropometric data, and the tests Development Scale Motor and the IPAQ short version. The variables were expressed as frequencies and proportions, the normality was tested with the Shapiro-Wilk test. Student t test was used to determine the statistical significance of normal data and Mann Whitney test for the non-normal data. Statistical significance was set at p <0.05. Results: The classification of BMI / age of both groups was eutrophic (53.3%) and the remainder (46.6%) were overweight. The sedentary group had better results in overall motor development, and the active group in balance and body scheme. Conclusion: The children who engage in extracurricular physical activity showed better development in balance and body structure, when compared to those that do not

Avaliação do equilíbrio de pacientes com distrofia muscular de Duchenne / Balance evaluation of patients with Duchenne muscular dystrophy

A distrofia muscular de Duchenne (DMD) é uma doença genética que afeta apenas indivíduos do gênero masculino, causando fraqueza muscular progressiva. Conforme a doença progride, surgem algumas outras alterações como, por exemplo, deformidades osteoarticulares e dificuldades na manutenção do equilíbrio estático e dinâmico. Objetivo: Avaliar o equilíbrio de pacientes com DMD deambuladores e comparar a participação da informação sensorial no ajuste postural destes pacientes. Método: Dez pacientes, entre sete e quatorze anos de idade, com diagnóstico de DMD foram avaliados pelo teste de organização sensorial modificada (OSM) da posturografia dinâmica computadorizada. O teste OSM consiste na manutenção da posição bípede sem movimentação sobre uma plataforma em quatro condições distintas: (1) olhos abertos e plataforma fixa, (2) olhos fechados e plataforma fixa, (3) olhos abertos e plataforma móvel, (4) condição olhos fechados e plataforma móvel. Foram avaliadas as seguintes variáveis: área de deslocamento do centro de pressão (COP) (cm²); COPx e COPy (deslocamento total do centro de pressão na base de suporte em cm, na direção médio-lateral e ântero-posterior); VMx e VMy (velocidade média do deslocamento do centro de pressão em cm/s). Para a análise dos dados foi utilizada análise de variância para medidas repetidas (ANOVA) tendo como fator as condições de teste, e análise de contraste ajustada para múltiplas comparações (Teste de Tukey) no caso de comparações significativas. Resultados: Não foram observadas diferenças significativas na área de excursão do centro de pressão nas diferentes condições de teste e no COPx e no COPy. Foi observada diferença significativa na VMx e na VMy entre as condições plataforma fixa/olhos abertos e plataforma móvel/olhos abertos, e entre as condições plataforma fixa/olhos fechados e plataforma móvel/olhos fechados. Conclusão: O teste OSM forneceu dados para a avaliação do equilíbrio desses pacientes, indicando que a privação dos sistemas somatossensorial e visual, em determinadas situações, não foi capaz de provocar grandes alterações de equilíbrio. Contudo, a velocidade do deslocamento do COP, que retrata o ajuste postural, é maior nas diferentes condições testadas.

Duchenne muscular dystrophy (DMD) is a genetic disease that affects only males. It causes progressive muscle weakness. As the disease develops other side effects occur, for example, osteoarticular deformities and difficulties in maintaining static and dynamic balance. Purpose: To evaluate the balance of patients with DMD that are able to walk and compare the involvement of sensory information in postural adjustment of these patients. Method: It was evaluated a total of ten patients from seven to fourteen years old, diagnosed with Duchenne muscular dystrophy, by the modified sensory organization test (OSM) of Computerized Dynamic Posturography. The OSM test is about the bipedal maintenance position, without movement, on a platform in four different situations: (1) eyes open and fixed platform, (2) eyes closed and fixed platform, (3) eyes open and mobile platform, (4) eyes closed and mobile platform. Those variables were evaluated: area of displacement of pressure center (COP) (cm²); COPx and COPY (total displacement of pressure center at the base of support in cm toward medio-lateral and antero-posterior); VMx and VMy (average speed of displacement of pressure center in cm/s). In order to analyze the data, analysis of variance for repeated measures (ANOVA) with the test conditions were used. The contrast analysis was adjusted for multiple comparisons (Turkey Test) in case of significant comparisons. Results: No significant difference was found in the area of excursion of pressure center in different test conditions and in COPx and COPy. The significant difference was observed in the VMx and VMy between fixed platform / eyes open and mobile platform/ eyes open conditions and between fixed platform/ eyes closed and mobile platform/ eyes closed conditions. Conclusion: The (OSM) test provided data for the assessing balance of these patients. The privation of somatosensory and visual system, in some instances, could not affect patient's balance. However, the speed of COP displacement, which shows the posture adjustment is increase in the different conditions tested.